Aerosol deliver apparatus IV

ABSTRACT

A multipurpose aerosol medication delivery apparatus that includes a collapsible/expandable, or a fixed volume, or a combination of partially fixed volume and partially collapsible/expandable holding chamber for use with a metered dosed inhaler (MDI) and/or any standard small volume nebulizer. The holding chamber is designed to deliver-aerosol medication particles generated by an MDI; aerosol medication particles generated by a nebulizer; a single gas or a mixture of gases; a single gas or a mixture of gases that can yield a gas density that will enhance aerosol delivery of medication with both MDI and nebulizer; a single gas or a mixture of gases that will yield and deliver an oxygen concentration to a patient ranging from room air concentration to 100%. The device includes a reservoir that stores nebulized aerosol generated during exhalation to be inhaled during the next breath. The device also included a one way valve to prevent carbon dioxide generated during exhalation from rebreathing by not allowing the exhaled air from entering the holding chamber. The device includes an exit port with a second one way valve that allows the exhaled air to exit the device but closes during inhalation to prevent any entrainment of room air gas. The exit port may instead have a filter with one-way valve to trap the exhaled aerosol particles while allowing the exhaled gases to escape. The filter valve will similarly close during inhalation to prevent entrainment of room air gas. The holding chamber will allow a uniform mixture of aerosol medication and gases to flow together during inhalation to the patient via a mouthpiece or a facemask. The holding chamber is connected to a nebulizer chamber with a single or multiple connecting tubes that allow gas mixtures with varying density, viscosity, humidity and concentration of oxygen to flow into the holding chamber from the nebulizer chamber. The pattern of flow of the gas(es) does not disturb the flow of the nebulized medication from the nebulizer chamber to the holding chamber or interfere with the plume generated by an MDI. The device also serves as a facemask for delivering precise concentrations of oxygen or as a 100% non-rebreather mask. The device also serves to deliver precise concentrations of different density gases i.e. nitrogen, helium, oxygen, etc. This will allow varying fractions of inspired oxygen to deliver aerosol medication via MDI or a nebulizer. Thus, the device has the ability to deliver aerosol medication with an MDI or a nebulizer while retaining the ability to simultaneously deliver different density gas mixtures and varying fraction of inspired oxygen without interrupting one for the other.

CROSS-REFERENCE TO RELATED APPLICATIONS

3967619 July, 1976 Story et al. 4484577 November, 1984 Sackner et al. 128/200 4534343 August, 1985 Nowacki et al. 128/203 4790305 December, 1988 Zoltain et al 128/203 4823784 April, 1989 Bordoni et al. 4926852 May, 1990 Zoltain et al. 128/203 5020530 June, 1991 Miller et al. 5027806 July, 1991 Zoltain et al. 128/203 5752502 May 1998 King et al. 128/200 4819629 April, 1989 Jonson 128/200 D272559 February, 1984 Guth D24/110 D295321 April, 1988 Hollworth D24/110 D342993 January, 1994 Fathi D24/110 D373630 September, 1996 Berg et al. D24/110 5139016 August, 1992 Waser 128/200 5178138 January, 1993 Walstrom et al. 128/200 5063921 November, 1991 Howe 128/200 D442685 May, 2001 Sladek 5738087 April, 1998 Key 128/200 5497765 March, 1996 Proud, et al 128/200 5431154 July, 1995 Siegel et al. 128/200 5078131 January, 1970 Greenfield 128/200 5320094 June, 1994 Lombe et al. 128/200 5617844 April, 1997 King 128/200 3187748 June, 1995 Mitchell et al. 128/200 5848587 December, 1998 King 128/200 US Pat. App. September, 2002 Johnson #20020121275

BACKGROUND OF THE INVENTION

This invention relates to an improved aerosol inhalation device and particularly to an aerosol enhancement device which:

-   -   can be used as a facemask to deliver precise fraction of         inspired oxygen     -   can be used as a 100% oxygen non-rebreather mask     -   can deliver a single gas or a mixture of gases to yield varying         gas densities that can enhance aerosol delivery     -   can deliver an individual gas like nitrogen, oxygen, room air,         helium, etc. or a single premixed gas or a mixture of individual         gases to yield a final mixture which can deliver 100% oxygen or         precise fraction of inspired oxygen or attain a mixture with a         desired gas density and a desired concentration of oxygen that         is physiologically compatible with life     -   can deliver aerosol medication with a metered dose inhaler     -   can deliver aerosol medication with standard small volume         nebulizer     -   can deliver aerosol medication with an MDI and/or a standard         small volume nebulizer simultaneously     -   can deliver aerosol medication with an MDI and/or a small volume         nebulizer and simultaneously deliver a desired gas density to         enhance aerosol delivery     -   can deliver aerosol medication with an MDI and/or a small volume         nebulizer; can deliver a desired gas density to enhance aerosol         delivery; and deliver a desired fraction of inspired oxygen to a         hypoxemic patient     -   includes a reservoir in the form of a bag or an         expandable/collapsible corrugated tubing for storage of aerosol         generated by a nebulizer during exhalation.     -   includes a valve system to prevent waste of medication generated         by a nebulizer chamber during exhalation and to prevent         rebreathing of exhaled carbon dioxide     -   includes a valve system to prevent entrainment of room air         during inhalation and for exit of carbon dioxide during         exhalation     -   can be used with a Continuous Positive Airway Pressure (CPAP) or         a Bi-level Positive Airway Pressure (BIPAP) system     -   can be introduced in a ventilatory circuit with the ability to         deliver aerosol medication with a metered dose inhaler and/or a         nebulizer     -   includes a filter system to trap exhaled aerosol particles while         allowing the exhaled gas (es) to escape into room air     -   includes a filter system with a valve to prevent entrainment of         room air during inhalation and to trap the exhaled aerosol         particles while allowing exhaled gas (es) to escape into room         air     -   includes a collapsible/expandable spacer device that can be         fully collapsed and made compact when not in use for delivery of         aerosol medications and be partially or fully expandable when in         use for aerosol medication delivery via an MDI or a nebulizer     -   can serve as an ambu-bag for resuscitation     -   can be used to deliver anesthetic gas (es)         MDI drug canisters are typically sold by manufacturers with a         boot that includes a nozzle, an actuator, and a mouthpiece.         Patients can self-administer the MDI medication using the boot         alone but the majority of patients have difficulty in         synchronizing the actuation of the MDI canister and inhalation         of the medication. Spacers or valved chambers have been used         with MDI boot to obviate the problem associated with patient         coordination by helping to synchronize the actuation of MDI         canister and patient inhalation and improve the delivery of         medication by decreasing oropharyngeal deposition of aerosol         drug. Many valved chambers of this type are commercially         available. Examples of such spacers are—AeroChamber, U.S. Pat.         Nos. 4,470,412 and 5,012,803; Optichamber, U.S. Pat. No.         5,385,140; Collapsible Chamber, U.S. Pat. Nos. 4,637,528 and         4,641,644; Disposable Chamber U.S. Pat. No. 4,953,545; or         Collapsible and Disposable Chamber U.S. Pat Application         No. 20020129814. These devices are expensive and may be alright         for chronic conditions that require frequent use of MDI inhalers         provided the cost and labor involved in frequent delivery of         medication is acceptable to the patient. However, under acute         symptoms, such devices may fail to serve the purpose and lead to         an inadequate delivery of medication.

Aerosol delivery devices that use standard small volume nebulizers are commonly used in acute conditions as they are cheap and overcome the inhalation difficulties associated with actuation of MDI and synchronization of inhalation by the patient. Nebulizers are fraught with numerous problems as well. The medication dose used is about 10 times of that used with an MDI and hence the increased cost without any added proven clinical benefit. Secondly, the majority of the nebulized medication is wasted during exhalation. Thirdly, the time taken to deliver the medication is several times that of an MDI and the labor cost of respiratory therapist may outweigh the benefits of nebulizers compared with MDIs. Breath actuated nebulizer (s) with reservoir have been designed to overcome the medication waste. Example of one such device is U.S. Pat. No. 5,752,502. However, these devices are expensive and still have all the other problems associated with nebulizer use alone. Other examples of aerosol inhalation devices would be U.S. Pat. No. 4,210,155, in which there is a fixed volume mist accumulation chamber for use in combination with a nebulizer and a TEE connection. Problems with prior art devices such as described are a significant waste of medication, a non-uniform concentration of delivered medication, expensive, and difficult to use. Many such devices are commercially available in which the nebulizer is directly attached to a TEE connector without any mixing chamber. All the afore mentioned devices can be used with either an MDI or a nebulizer but not both, and hence, face the difficultly associated with either system alone. Other devices have tried to overcome the above problems by incorporating a mixing chamber in the device with adaptability to be used with an MDI or standard nebulizer. U.S. Pat. Application No. 20020121275 is an example of one such device. However, the device is plagued with problems typical of such devices. Just like other prior art devices, this device as well fails to incorporate some of the key the features necessary for enhanced aerosol delivery. A list of problems associated with this device and other similar devices are outlined below:

-   (1) The entrained airflow in this device interferes with the MDI     plume as well as the plume generated by a nebulizer resulting in     increased impaction losses of aerosol generated by either an MDI or     nebulizer. -   (2) The device does not have the ability to deliver a desired     precise fraction of inspired oxygen to a hypoxic patient and     simultaneously deliver aerosol medication with either a metered dose     inhaler or a nebulizer. -   (3) The device cannot deliver a gas with a desired density to     improve aerosol delivery and a desired fraction of inspired oxygen     to a hypoxemic patient -   (4) The device does not have the ability to deliver different     density gases with a desired fraction of inspired oxygen     simultaneously while retaining the ability to deliver aerosol     medication at the same time with either an MDI or a nebulizer -   (5) the device does not have the ability to deliver a mixture of     multiple gases to a patient and simultaneously maintain a desired     fraction of inspired oxygen -   (6) the device does not serve as a facemask for delivering varying     concentrations of inspired oxygen from room air to 100% but serves     solely as an aerosol delivery device -   (7) the device does not have a reservoir chamber-either as a bag or     as a large volume tubing t store nebulized medication that is     otherwise wasted during exhalation. The holding chamber of this     device varies from 90 cc to 140 cc and is not enough to serve as a     reservoir for the volume of nebulized medication generated during     exhalation and hence in a normal sized adult most of the medication     generated during exhalation is wasted -   (8) there is no mechanism in the device to prevent entrainment of     room air which forms the bulk of volume during inhalation. The     fraction of inspired oxygen and the density of gas mixture inhaled     by the patient may vary with every breath with this device depending     on the volume of entrained room air which may vary with each breath -   (9) the device does not have any valve system to prevent exhaled     carbon dioxide from entering the holding chamber. Rebreathing of     carbon dioxide from the holding chamber on subsequent inhalation can     be extremely detrimental to a patient and extremely dangerous under     certain clinical conditions -   (10) the device does not have the capability of delivering     medication with an MDI and a nebulizer simultaneously -   (11) the device has a fixed volume-holding chamber, which makes the     device extremely large and cumbersome to deliver medication.

Our device overcomes all the difficulties and problems associated with this and all the prior art devices. Our device incorporates all the desired features to make it a compact, user friendly economical, and multipurpose aerosol device for both acute and chronic use with either an MDI or a nebulizer or with both MDI and nebulizer simultaneously as warranted by the patient's clinical circumstances. Our device also retains the ability to deliver a desired fraction of inspired oxygen and deliver a desired gas density to decrease the work of breathing and simultaneously deliver and enhance aerosol medication delivery.

SUMMARY OF THE INVENTION

The present invention provides an aerosol medication delivery apparatus, which incorporates the aforementioned advantages. The inventive device includes a fixed volume or a collapsible/expandable MDI holding chamber, a fixed volume or a collapsible/expandable nebulizer chamber, a system of connecting the two chambers with 2 or more hollow collapsible/expandable or fixed volume cylindrical connecting tubes. The MDI holding chamber maybe a fixed volume chamber or a collapsible/expandable chamber or a combination of the two i.e., partly fixed and partly collapsible/expandable chamber. The collapsible feature of the device makes it compact when solely in use for delivery of single gas or different gas mixtures while the expandable feature can be utilized when delivering aerosol medication with an MDI and/or a nebulizer.

The collapsible/expandable MDI chamber has a hollow cylindrical rigid inlet port at one end and a similar outlet port at the other end. When fully collapsed the outlet and the inlet port may be fused to each other to form a continuous hollow rigid cylindrical tube. When the holding chamber is fully expanded the outlet and inlet tubes stay disconnected. The holding chamber may be kept patent by internal support with a coiled metal or plastic wire. The rings of the coiled wire come together when the chamber is collapsed and stay separated when it is expanded. Alternatively, the MDI chamber may be constructed with a collapsible/expandable corrugated plastic tubing, which does not require any coiled metal or plastic wire support for maintaining patency of the chamber. The volume of the chamber may vary form 0.10 liters to 2.0 liters to accommodate both pediatric and adult patients. When partially or fully expanded, the chamber may also serve as a reservoir to prevent aerosol generated during exhalation from being wasted.

The central rigid inlet port is connected to a universal boot adapter panel with an opening to accommodate the boot of any commercially available MDI such that medication can be delivered to the MDI chamber on actuation of the MDI canister. For aerosol delivery with nebuliser, the universal boot adapter is disconnected from the inlet port, which now fuses with the outlet port of the nebulizer chamber. The inlet of the MDI chamber is connected to the outlet to the nebulizer chamber with two additional peripheral hollow cylindrical connecting tubes; the two tubes have two outlet ports at 3 and 9 o'clock positions in the nebulizer chamber and two inlet ports in similar locations in the MDI chamber. The distance between the connecting tubes and the length of the connecting tubes allows for any commercially available MDI boot to be accommodated easily between the MDI and the nebulizer chambers. At the inlet end of the MDI chamber, the peripheral hollow cylindrical connecting tubes split into multiple micrometric openings that are distributed at intervals along the entire circumference of the MDI chamber's inlet. This allows the flow of gas(es) from the two openings in the nebulizer chambers outlet to the multiple openings distributed all along the circumference of the MDI chamber's inlet. The pattern of flow of the gas(es) through multiple openings that are distributed along the circumference of the MDI chamber's inlet is such that it does not interfere with the plume of the MDI when it is actuated. Also this arrangement allows different desired density gas(es) with a desired fraction of inspired oxygen to flow into the MDI chamber to enhance aerosol delivery from MDI and to deliver oxygen to a patient if necessary. The flow pattern of the gas(es) in addition minimizes the impaction losses of aerosol generated by an MDI.

The outlet rigid tube of the MDI chamber has an inhalation flap valve and a flap seat. The flap valve moves away from the flap valve seat on inhalation to allow the flow of medication from the MDI chamber to the patient. On exhalation the flap valve presses against the flap valve seat which prevents carbon dioxide exhaled during exhalation from entering into the MDI chamber. The outlet tube has an exhalation flap valve assembly with an exhalation flap valve and a valve seat on the superior or inferior surface. The flap valve moves away from the flap valve seat on exhalation to allow the exhaled gases to exit the outlet tube and presses against the valve seat on inhalation to prevent any entrainment of any room air gases on inhalation. The provision of a filter at this opening may be optional depending on the conditions under which aerosol is being delivered. The filter can trap all exhaled aerosol particles while allowing the gases to exit from this port. A flap valve may again be provided at the end of the filter to prevent entrainment of room air gas during inhalation and to allow exit of all exhaled gas(es).

The nebulizer chamber has an inlet port with a central cylindrical hollow rigid tube for entry of one or more gases into the nebulizer chamber; an outlet port, a port for a nebulizer, and a port for a reservoir (a bag reservoir or a collapsible/expandable corrugated plastic tubing reservoir), the reservoir bag has one or more inlet ports for inflow of desired gases. There are two additional openings at 3 and 9 o'clock positions for connection of peripheral tubes that connect the MDI chamber and the nebulizer chamber. The outlet of the nebulizer chamber has a rigid hollow cylindrical tube similar to that seen in the MDI chamber's inlet. The port of the nebulizer chamber remains plugged with a cap when MDI is in use. The cap is unplugged and the outlet port of the nebulizer fuses with the inlet port of the MDI chamber when nebulizer is to be used. When aerosol delivery is desired with a nebulizer, the nebulizer is connected to the nebulizer port, the nebulized medication flows through the peripheral connecting tubes between the MDI chamber and the nebulizer chamber through multiple openings distributed along the circumference of the MDI chamber's inlet. The universal boot adapter assembly may be disconnected from the central rigid tube of MDI the chamber, which could now be plugged with a cap. Alternatively, the central inlet tube of the MDI chamber and the central outlet tube of the nebulizer chamber can both uncapped and the two tubes fused to each other by moving the MDI chamber closer to the nebulizer chamber by collapsing the peripheral connecting tubes. The aerosol generated by the nebulizer can now flow from the nebulizer chamber to the MDI chamber via the central connection between the MDI chamber and the nebulizer chamber, as well as via the peripheral connections between the two chambers via the peripheral connecting tubes at 3 and 9 o'clock positions. The connecting tubes between the MDI and nebulizer chambers are made collapsible/expandable in a manner identical to the principles of the expandable/collapsible MDI chamber itself. This will allow the MDI and the nebulizer chambers to be moved closer to each other to be fused during nebulizer operation or to be disconnected and moved apart to accommodate MDI in the space between the MDI and the nebulizer chambers during MDI operation.

The aerosol reservoir may comprise of a collapsible/expandable bag made of plastic or neoprene, a fixed chamber, or a collapsible/expandable corrugated plastic tubing. The volume of the reservoir could vary from 0.1 liter to 2.0 liters to meet the needs of both pediatric and adult patients. The reservoir could be attached to a reservoir port in the nebulizer chamber or alternatively it could be attached to the inlet port of the nebulizer chamber to store the aerosol generated during exhalation which would otherwise, have been wasted as is the case with most TEE nebulizers. During the subsequent inhalation the aerosol stored in the reservoir bag during exhalation would flow from the nebulizer chamber into the MDI chamber via central and/or peripheral connections and then through the mouthpiece or facemask to the patient.

Additional inlet ports may be available directly on the nebulizer chamber or on the reservoir bag or on the corrugated plastic tubing reservoir which will allow one of more, unmixed or premixed gases to flow into the nebulizer chamber and/or the reservoir at different flow rates to achieve a desired density, viscosity, humidity and fraction of inspired oxygen to simultaneously enhance medication delivery and deliver oxygen to a hypoxemic patient. The gases used may be oxygen, nitrogen, helium, heliox (premixed), room air, various anesthesia gases, various diagnostic gases, i.e. xenon, krypton etc. When not in use for aerosol delivery either via MDI or nebulizer the device could be used solely to deliver desired oxygen concentration or other aforementioned gases via a facemask which can be connected to outlet of the MDI chamber. The equipment in this case will be made extremely compact by fully collapsing the MDI chamber, fully collapsing the peripheral connecting tubes, and fully collapsing the corrugated plastic reservoir tubing connected to the nebulizer chamber. The nebulizer outlet port in the nebulizer chamber may be plugged with a cap when only delivering a gas without aerosolized medication or the inlet port of MDI chamber and the outlet port of the nebulizer chamber may be fused. The desired gas(es) can now flow to the patient from the reservoir bag/tubing to the MDI chamber via the central and/or peripheral connections between the two chambers and to the patient via a facemask.

The device can also be incorporated into the inspiratory limb of the ventilatory circuit by making connections at two sites—between the inspiratory tubing and the outlet port of the MDI chamber at one end and between the inlet port of the nebulizer chamber and the inspiratory tubing at the other end. The device can now deliver aerosol medication with MDI or nebulizer to the patient on mechanical ventilation. This arrangement will have the distinct advantage of delivering the precise dose via MDI (ex-actuator) as specified by the manufacturer. This arrangement allows the MDI canister to be actuated using the MDI boot and actuator as specified by the manufacturers as opposed to commercially available custom designed universal actuators that are currently available to fit nozzles of various MDIs. Hence, this mode of delivery is different from all the prior art devices which have used custom designed universal actuators in ventilatory circuit to deliver aerosol by MDI as those devices fail to meet the ex-actuator delivery of dose as specified by the manufacturer. Hence, the ex-actuator dose output for each MDI will be different from that specified by the manufacturer. Our device obviates that problem.

Alternatively, our device, like numerous prior art devices, can incorporate a custom designed universal actuator on the inlet port of the MDI chamber to accommodate the nozzles of all commercially available MDI canisters to deliver aerosol via MDI, as opposed to a universal MDI boot assembly to accommodate the boot of all commercially available MDIs. In this case all other features of the device would remain the same except that the MDI chamber and the nebulizer chamber may be fused at the center without any connecting tubes at the 3 and 9 o'clock positions. Alternatively, the nebulizer and MDI chambers maybe connected only at peripheral 3 and 9 o'clock positions with collapsible connecting tubes or fixed rigid tubes without intervening space between the MDI and the nebulizer chambers for MDI boot assembly which will no longer be required. Alternatively, nebulizer and MDI chambers maybe connected or fused at both central and peripheral locations.

Alternatively, the collapsible/expandable MDI chamber and the collapsible/expandable MDI chamber may be fused to form a single chamber and the MDI boot assembly instead of now being fitted at the inlet of the MDI chamber fits at the inlet of the nebulizer chamber where an MDI boot can be attached to deliver aerosol medication via MDI. The boot assembly may also be designed to accommodate a nebulizer Tee piece which may generate aerosol particles via a nebulizer to deliver it into the collapsible/expandable MDI and nebulizer chambers. The Tee piece in this case will have one end of the horizontal limb completely closed so that no aerosol particles will escape out of the holding chamber during exhalation phase and there may be no need for a reservoir bag as the collapsible/expandable tubing of the MDI and nebulizer chambers when expanded will create a volume that will serve as a reservoir for storage of aerosol medication generated during the exhalation phase. Alternatively, the Tee piece may be open at both ends, one open end of which may be connected to the inlet of the nebulizer chamber and the other free end of which may be connected to a second Tee piece. The vertical limb of the second Tee piece may now serve as the inlet for the reservoir bag or the corrugated reservoir tubing and one end of the horizontal limb of the second Tee piece remaining closed.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

Further features of the present invention will become apparent in the accompanied drawings as well as the detailed description of the preferred embodiments.

FIG. 1A and FIG. 1B are plan views of the longitudinal length of aerosol delivery apparatus IV according to one embodiment of the present invention, incorporating the features described in the summary of the invention.

FIG. 1C and FIG. 1D are plan views of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention.

FIG. 1E and FIG. 1F are plan views of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention.

FIG. 2A and FIG. 2B are plan views of the longitudinal length of aerosol delivery apparatus IV according to the third alternative embodiment of the present invention.

FIG. 2C and FIG. 2D are plan views of the longitudinal length of aerosol delivery apparatus IV according to the fourth alternative embodiment of the present invention.

FIG. 2E and FIG. 2F are plan views of the longitudinal length of aerosol delivery apparatus IV according to the fifth alternative embodiment of the present invention.

FIG. 3A and FIG. 3B are expanded plan views of MDI chamber 1 a according to the present invention as described in FIG. 1A.

FIG. 3C is an expanded plan view of MDI chamber 1 a according the first alternative embodiment of the present invention as described in FIG. 3A and FIG. 3B.

FIG. 3D and FIG. 3E are expanded plan views of MDI chamber 1 a according to the second alternative embodiment of the present invention as described in FIGS. 3A and 3B.

FIG. 3F is an expanded plan view of MDI chamber 1 a according to the third alternative embodiment of the present invention as described in FIGS. 3A and 3B.

FIG. 3G and FIG. 3H are expanded plan views of MDI chamber 1 a according to the fourth alternative embodiment of the present invention as described in FIGS. 3A and 3B.

FIG. 3I is an expanded plan view of MDI chamber 1 a according to the fifth alternative embodiment of the present invention as described in FIGS. 3A and 3B.

FIGS. 4A and 4B are expanded plan views of tubes 50 a or 51 a according to the present invention as described in FIG. 1A.

FIGS. 4C and 4D are expanded plan views of tubes 50 a or 51 a according to the first alternative embodiment of the present invention as described in FIGS. 4A and 4B.

FIGS. 4E and 4F are expanded plan views of tubes 50 a or 51 a according to the second alternative embodiment of the present invention as described in FIGS. 4A and 4B.

FIG. 5A is an expanded cross-sectional view of the inlet end 2 a of the invention as described in FIG. 1A.

FIG. 5B is an expanded cross-sectional view of the inlet end 2 a according to the first alternative embodiment of the present invention as described in FIG. 5A.

FIG. 6A is an expanded cross-sectional view of the inhalation/exhalation valve assemblies 32 a or 35 a of the invention as described in FIG. 1A.

FIG. 6B is an expanded cross-sectional view of the inhalation/exhalation valve assemblies 32 a or 35 a of the first alternative embodiment of the present invention as described in FIG. 6A.

FIG. 6C is an expanded cross-sectional view of the inhalation/exhalation valve assemblies 32 a or 35 a of the second alternative embodiment of the present invention as described in FIG. 6A.

FIG. 7A is a plan view of the longitudinal length of the mouthpiece according to one embodiment of the present invention.

FIG. 7B is a plan view of the longitudinal length of the facemask according to one embodiment of the present invention.

FIG. 8A is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to alternative embodiment of the present invention as described in FIG. 1E.

FIG. 8B is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention as described in FIG. 8A.

FIG. 8C is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention as described in FIG. 8A.

FIG. 8D is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the alternative embodiment of the present invention as described in FIG. 2E.

FIG. 8E is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention as described in FIG. 8D.

FIG. 8F is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention as described in FIG. 8D.

DETAILED DESCRIPTION OF THE INVENTION

The present invention will now be described in detail by reference to the drawing figures, where as like parts as indicated by like reference numerals.

FIG. 1A is a plan view of the longitudinal length of aerosol delivery apparatus IV according to one embodiment of the present invention, incorporating the features described in the summary of the invention. FIG. 1A is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber 1 a, and a nebulizer chamber 4 a. The MDI chamber 1 a has an inlet end 2 a and an outlet end 3 a. The nebulizer chamber 4 a similarly has an inlet end 5 a and an outlet end 6 a. The inlet end 2 a has three hollow cylindrical inlet tubes, a central tube 7 a and two peripheral tubes 10 a and 13 a located at three o'clock to nine o'clock positions, respectively. The central hollow cylindrical tube 7 a has an inlet end 8 a and an outlet end 9 a. The peripheral tube 10 a has an inlet end 11 a and an outlet end 12 a and the peripheral tube 13 a similarly has an inlet end 14 a and an outlet ed 15 a. The outlet end 3 a of the MDI chamber 1 a has a hollow cylindrical tube 16 a with an inlet end 17 a and an outlet end 18 a. The MDI chamber 1 a may be made of plastic, paper, or metal. The chamber 1 a may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 19 a and grooves 20 a. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 21 a of the coil are demonstrated in the figure as dotted lines. The distance 22 a and 23 a between the two adjacent ridges, rings of the coil, or grooves may be equal. Alternatively, the chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. The figure demonstrates the expanded illustration of the MDI camber 1 a.

The inlet end 8 a of the central tube 7 a is attached to the outlet end 27 a of the boot 25 a of a metered dose inhaler 24 a. The inhaler 24 a has a boot 25 a with an inlet end 26 a and an outlet end 27 a. A canister 28 a is introduced into the boot 25 a through the inlet end 26 a and the nozzle 29 a of the MDI 24 a is attached to an actuator 30 a. The actuator 30 a has an opening or an aperture 31 a. On actuation of the MDI canister 28 a, the medication aerosol particles are generated through the opening 31 a of the actuator 30 a, and enter into the chamber 1 a through the outlet end 9 a of the central tube 7 a.

The outlet tube 16 a of the MDI chamber 1 a has two valve assemblies disposed between the inlet end 17 a and the outlet end 18 a—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 32 a that has a circular opening 33 a and a flap valve 34 a as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 35 a that has a circular opening 36 a and a flap valve 37 a as demonstrated by the dotted line. On inhalation, the inhalation flap valve 34 a moves away from the valve seat 32 a for the aerosol particles to move from the MDI chamber 1 a to the patient through the opening 33 a in the valve seat 32 a of the tube 16 a. On exhalation, the flap valve 34 a moves towards the flap valve seat 32 a and closes the opening 33 a to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 1 a thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 32 a prevents any protrusion of the flap valve 34 a through the opening 33 a. The exhalation flap valve assembly has a flap valve 37 a that presses against the flap valve seat 35 a on inhalation and completely occludes the opening 36 a to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 16 a on inhalation. On exhalation the flap valve 37 a moves away from the flap valve seat 35 a for the air exhaled by the patient to escape into the atmosphere from tube 16 a through the opening 36 a.

The nebulizer chamber 4 a has a hollow cylindrical inlet tube 38 a with an inlet end 39 a and an outlet end 40 a. The inlet and 39 a can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber 4 a has a hollow cylindrical outlet tube 41 a that has an inlet end 42 a and an outlet end 43 a. The outlet end 43 a may remain plugged with a cap when the device is in use with a metered dose inhaler. The nebulizer chamber also has two hollow cylindrical tubes, 44 a and 47 a, at three o'clock and nine o'clock positions. Tube 44 a has an inlet end 45 a and an outlet end 46 a, whereas the tube 47 a has an inlet end 48 a and an outlet end 49 a. The inlet end 1 a of the tube 10 a the inlet end 5 a of the MDI chamber 1 a is connected to the outlet end 46 a of the tube 44 a at the outlet end 6 a of the nebulizer chamber 4 a with a collapsible/expandable stiff corrugated plastic tubing 50 a and similarly the inlet end 14 a of tube 13 a is connected to the outlet end 49 a of tube 47 a with a collapsible/expandable corrugated plastic tubing 51 a. The collapsible/expandable tubings 50 a and 51 a are demonstrated to be fully expanded in FIG. 1A to accommodate MDI boot 25 a between the MDI chamber 1 a and the nebulizer chamber 4 a.

The nebulizer chamber has an inlet port 52 a for connection with a standard small volume nebulizer 53 a. Chamber 4 a also has another inlet 54 a for connection to a reservoir bag 55 a. The reservoir bag 55 a serves to store the aerosol particles generated by the nebulizer 53 a during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 55 a has two small inlets 56 a and 57 a to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 1B is a plan view of the longitudinal length of aerosol delivery apparatus IV according to one embodiment of the present invention, incorporating the features described in the summary of the invention. FIG. 1B is a plan view of the invention just like the one described in FIG. 1A that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber 1 b, and a nebulizer chamber 4 b. The MDI chamber 1 b has an inlet end 2 b and an outlet end 3 b. The nebulizer chamber 4 b similarly has an inlet end 5 b and an outlet end 6 b. The inlet end 2 b has three hollow cylindrical inlet tubes, a central tube 7 b and two peripheral tubes 10 b and 13 b located at three o'clock to nine o'clock positions. The central hollow cylindrical tube 7 b has an inlet end 8 b and an outlet end 9 b. The peripheral tube 10 b has an inlet end 11 b and an outlet end 12 b and the peripheral tube 13 b similarly has an inlet end 14 b and an outlet ed 15 b. The outlet end 3 b of the MDI chamber 1 b has a hollow cylindrical tube 16 b with an inlet end 17 b and an outlet end 18 b. The MDI chamber 1 b may be made of plastic, paper, or metal just as described in FIG. 1A. Chamber 1 b is a collapsible/expandable cylindrical chamber with multiple ridges 19 b and grooves 20 b. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 21 b of the coil are demonstrated in the figure as dotted lines. The MDI chamber 1 b in this figure is demonstrated to be fully or partially collapsed. The distance 22 b and 23 b between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. When fully collapsed, the inlet end 17 b of the tube 16 b may be fused to the outlet end 9 b of the tube 7 b.

The inlet end 8 b of the tube 7 b is attached to the outlet end 27 b of the boot 25 b of a metered dose inhaler 24 b. The inhaler 24 b has a boot 25 b with an inlet end 26 b and an outlet end 27 b. A canister 28 b is introduced into the boot 25 b through the inlet end 26 b and the nozzle 29 b of the MDI 24 b is attached to an actuator 30 b. The actuator 30 b has an opening or an aperture 31 b. On actuation of the MDI canister 28 b, the medication aerosol particles are generated through the opening 31 b of the actuator 30 b, and enter into the chamber 1 b through the outlet end 9 b of the tube 7 b.

The outlet tube 16 b of the MDI chamber 1 b has two valve assemblies disposed between the inlet end 17 b and the outlet end 18 b—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 32 b that has a circular opening 33 b and a flap valve 34 b as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 35 b that has a circular opening 36 b and a flap valve 37 b as demonstrated by the dotted line. On inhalation, the inhalation flap valve 34 a moves away from the valve seat 32 b for the aerosol particles to move from the MDI chamber 1 b to the patient through the opening 33 b in the valve seat 32 b of the tube 16 b. On exhalation, the flap valve 34 b moves towards the flap valve seat 32 b and closes the opening 33 b to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 1 a thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 32 b prevents any protrusion of the flap valve 34 b through the opening 33 b. The exhalation flap valve assembly has a flap valve 37 b that presses against the flap valve seat 35 b on inhalation and completely occludes the opening 36 b to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 16 b on inhalation. On exhalation the flap valve 37 b moves away from the flap valve seat 35 b for the air exhaled by the patient to escape into the atmosphere from tube 16 b through the opening 36 b.

The nebulizer chamber 4 b has a hollow cylindrical inlet tube 38 b with an inlet end 39 b and an outlet end 40 b. The inlet and 39 b can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber 4 b has a hollow cylindrical outlet tube 41 b that has an inlet end 42 b and an outlet end 43 b. The outlet end 43 b may remain plugged with a cap when the device is in use with a metered dose inhaler. The nebulizer chamber also has two hollow cylindrical tubes, 44 b and 47 b, at three o'clock and nine o'clock positions. Tube 44 b has an inlet end 45 b and an outlet end 46 b, whereas the tube 47 b has an inlet end 48 b and an outlet end 49 b. The inlet end 11 b of the tube 10 b is connected to the outlet end 46 b of the tube 44 b with a collapsible/expandable stiff corrugated plastic tubing 50 b and similarly the inlet end 14 b of tube 13 b is connected to the outlet end 49 b of tube 47 b with a collapsible/expandable corrugated plastic tubing 51 b. The collapsible/expandable tubings 50 b and 51 b are demonstrated to be fully expanded in FIG. 1B to accommodate MDI boot 25 b between the MDI chamber 1 b and the nebulizer chamber 4 b.

The nebulizer chamber has an inlet port 52 b for connection with a standard small volume nebulizer 53 b. Chamber 4 b also has another inlet 54 b for connection to a reservoir bag 55 b. The reservoir bag 55 b serves to store the aerosol particles generated by the nebulizer 53 b during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 55 b has two small inlets 56 b and 57 b to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 1C is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention. FIG. 1C is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with a nebulizer. The device has two hollow chambers, a metered dose inhaler chamber 1 c, and a nebulizer chamber 4 c. The MDI chamber 1 a has an inlet end 2 c and an outlet end 3 c. The nebulizer chamber 4 c similarly has an inlet end 5 c and an outlet end 6 c. The inlet end 2 c has three hollow cylindrical inlet tubes, a central tube 7 c and two peripheral tubes 10 c and 13 c located at three o'clock to nine o'clock positions. The central hollow cylindrical tube 7 c has an inlet end 8 c and an outlet end 9 c. The peripheral tube 10 c has an inlet end 11 c and an outlet end 12 c and the peripheral tube 13 c similarly has an inlet end 14 c and an outlet ed 15 c. The outlet end 3 c of the MDI chamber 1 c has a hollow cylindrical tube 16 c with an inlet end 17 c and an outlet end 18 c. The MDI chamber 1 c may be made of plastic, paper, or metal. The chamber 1 c may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 19 c and grooves 20 c. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 21 c of the coil are demonstrated in the figure as dotted lines. The distance 22 c and 23 c between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber 1 c in this figure is illustrated as fully expanded. The inlet end 8 c of the tube 7 c is not attached to the MDI 24 c as demonstrated in FIG. 1A. The MDI 24 c is demonstrated separately in this figure The inhaler 24 c has a boot 25 c with an inlet end 26 c and an outlet end 27 c. A canister 28 c is introduced into the boot 25 c through the inlet end 26 c and the nozzle 29 c of the MDI 24 c is attached to an actuator 30 c. The actuator 30 c has an opening or an aperture 31 c. On actuation of the MDI canister 28 c, the medication aerosol particles are generated through the opening 31 c of the actuator 30 c.

The outlet tube 16 c of the MDI chamber 1 c has two valve assemblies disposed between the inlet end 17 c and the outlet end 18 c—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 32 c that has a circular opening 33 c and a flap valve 34 c as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 35 c that has a circular opening 36 c and a flap valve 37 c as demonstrated by the dotted line. On inhalation, the inhalation flap valve 34 c moves away from the valve seat 32 c for the aerosol particles to move from the MDI chamber 1 c to the patient through the opening 33 c in the valve seat 32 c of the tube 16 c. On exhalation, the flap valve 34 c moves towards the flap valve seat 32 c and closes the opening 33 c to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 1 c thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 32 c prevents any protrusion of the flap valve 34 c through the opening 33 c. The exhalation flap valve assembly has a flap valve 37 c that presses against the flap valve seat 35 c on inhalation and completely occludes the opening 36 c to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 16 c on inhalation. On exhalation the flap valve 37 c moves away from the flap valve seat 35 c for the air exhaled by the patient to escape into the atmosphere from tube 16 c through the opening 36 c.

The nebulizer chamber 4 c has a hollow cylindrical inlet tube 38 c with an inlet end 39 c and an outlet end 40 c. The inlet and 39 c can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber 4 c has a hollow cylindrical outlet tube 41 c that has an inlet end 42 c and an outlet end 43 c. The nebulizer chamber also has two hollow cylindrical tubes, 44 c and 47 c, at three o'clock and nine o'clock positions. Tube 44 c has an inlet end 45 c and an outlet end 46 c, whereas the tube 47 a has an inlet end 48 c and an outlet end 49 c. The inlet end 11 c of the tube 10 c is connected to the outlet end 46 c of the tube 4 c with a collapsible/expandable stiff corrugated plastic tubing 50 c and similarly the inlet end 14 c of tube 13 c is connected to the outlet end 49 c of tube 47 c with a collapsible/expandable corrugated plastic tubing 51 c. Quite unlike FIG. 1A the collapsible/expandable tubings 50 c and 51 c are now demonstrated to be collapsed but still fully patent. The inlet end 9 c of the tube 7 c is now fused to the outlet end 43 c of the tube 41 c. The inlet ends 11 c and 14 c may be fused to the outlet ends 46 c and 49 c respectively or may stay separated.

The nebulizer chamber has an inlet port 52 c for connection with a standard small volume nebulizer 53 c. The aerosol medication generated with the nebulizer 53 c can enter the MDI chamber via a central connection between the tubes 7 c and 41 c or through the peripheral connections between the tubes 10 c and 44 c, and 13 c and 47 c. Chamber 4 c also has another inlet 54 c for connection to a reservoir bag 55 c. The reservoir bag 55 c serves to store the aerosol particles generated by the nebulizer 53 c during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 55 c has two small inlets 56 c and 57 c to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The MDI 24 c can be connected to the inlet 40 c and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber 4 c to the MDI chamber 1 c via the central and two peripheral connections between the two chambers as described before.

FIG. 1D is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention. FIG. 1D is a perspective view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with a nebulizer. The device has two hollow chambers, a metered dose inhaler chamber 1 d, and a nebulizer chamber 4 d. The MDI chamber 1 d has an inlet end 2 d and an outlet end 3 d. The nebulizer chamber 4 d similarly has an inlet end 5 d and an outlet end 6 d. The inlet end 2 d has three hollow cylindrical inlet tubes, a central tube 7 d and two peripheral tubes 10 d and 13 d located at three o'clock to nine o'clock positions. The central hollow cylindrical tube 7 d has an inlet end 8 d and an outlet end 9 d. The peripheral tube 10 d has an inlet end 11 d and an outlet end 12 d and the peripheral tube 13 d similarly has an inlet end 14 d and an outlet 15 d. The outlet end 3 d of the MDI chamber 1 d has a hollow cylindrical tube 16 d with an inlet end 17 d and an outlet end 18 d. The MDI chamber 1 a may be made of plastic, paper, or metal. The chamber 1 a may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 19 d and grooves 20 d. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 21 d of the coil are demonstrated in the figure as dotted lines. The chamber 1 d in this figure is demonstrated to be fully or partially collapsed The distance 22 d and 23 d between the two adjacent ridges; rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. When fully collapsed, the inlet end 17 d of the tube 16 d may be fused to the outlet end 9 d of the tube 7 d. The distance 22 d and 23 d between the two adjacent ridges, rings of the coil, or grooves may be equal. The inlet end 8 d of the tube 7 d is not attached to the MDI 24 d as demonstrated in FIG. 1A. The MDI 24 d is demonstrated separately in this figure. The inhaler 24 d has a boot 25 d with an inlet end 26 d and an outlet end 27 d. A canister 28 d is introduced into the boot 25 d through the inlet end 26 d and the nozzle 29 d of the MDI 24 d is attached to an actuator 30 d. The actuator 30 d has an opening or an aperture 31 d. On actuation of the MDI canister 28 d, the medication aerosol particles are generated through the opening 31 d of the actuator 30 d.

The outlet tube 16 d of the MDI chamber 1 d has two valve assemblies disposed between the inlet end 17 d and the outlet end 18 d—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 32 d that has a circular opening 33 d and a flap valve 34 d as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 35 d that has a circular opening 36 d and a flap valve 37 d as demonstrated by the dotted line. On inhalation, the inhalation flap valve 34 d moves away from the valve seat 32 d for the aerosol particles to move from the MDI chamber 1 d to the patient through the opening 33 d in the valve seat 32 d of the tube 16 d. On exhalation, the flap valve 34 d moves towards the flap valve seat 32 d and closes the opening 33 d to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 1 d thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 32 d prevents any protrusion of the flap valve 34 d through the opening 33 d. The exhalation flap valve assembly has a flap valve 37 d that presses against the flap valve seat 35 d on inhalation and completely occludes the opening 36 d to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 16 d on inhalation. On exhalation the flap valve 37 d moves away from the flap valve seat 35 d for the air exhaled by the patient to escape into the atmosphere from tube 16 d through the opening 36 d.

The nebulizer chamber 4 d has a hollow cylindrical inlet tube 38 d with an inlet end 39 d and an outlet end 40 d. The inlet and 39 d can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber 4 d has a hollow cylindrical outlet tube 41 d that has an inlet end 42 d and an outlet end 43 d. The nebulizer chamber also has two hollow cylindrical tubes, 44 d and 47 d, at three o'clock and nine o'clock positions. Tube 44 d has an inlet end 45 d and an outlet end 46 d, whereas the tube 47 d has an inlet end 48 d and an outlet end 49 d. The inlet end 1 d of the tube 10 d is connected to the outlet end 46 d of the tube 44 d with a collapsible/expandable stiff corrugated plastic tubing 50 d and similarly the inlet end 14 d of tube 13 d is connected to the outlet end 49 d of tube 47 d with a collapsible/expandable corrugated plastic tubing 51 d. Quite unlike FIG. 1A the collapsible/expandable tubings 50 d and 51 d are now demonstrated to be collapsed but still fully patent. The inlet end 9 d of the tube 7 d is now fused to the outlet end 43 d of the tube 41 d. The inlet ends 11 d and 14 d may be fused to the outlet ends 46 d and 49 d respectively or may stay separated.

The nebulizer chamber has an inlet port 52 d for connection with a standard small volume nebulizer 53 d. The aerosol medication generated with the nebulizer 53 d can enter the MDI chamber via a central connection between the tubes 7 d and 41 d or through the peripheral connections between the tubes 10 d and 44 d, and 13 d and 47 d. Chamber 4 d also has another inlet 54 d for connection to a reservoir bag 55 d. The reservoir bag 55 d serves to store the aerosol particles generated by the nebulizer 53 d during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 55 d has two small inlets 56 d and 57 d to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 1E is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention. FIG. 1E is a perspective view of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The MDI chamber 1 e has an outlet end 3 e. The nebulizer chamber 4 e has an inlet end 5 e. The inlet end of the MDI chamber 1 e and the outlet end of the nebulizer chamber 4 e are fused together, the point of fusion is labeled as 2 e 6 e. The outlet end 3 e of the MDI chamber 1 e has a hollow cylindrical tube 16 e with an inlet end 17 e and an outlet end 18 e. The MDI chamber 1 e may be made of plastic, paper, or metal. The chamber 1 e may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 19 e and grooves 20 e. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 21 e of the coil are demonstrated in the figure as dotted lines. The distance 22 e and 23 e between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber le in this figure is illustrated as fully expanded.

The outlet tube 16 e of the MDI chamber 1 e has two valve assemblies disposed between the inlet end 17 e and the outlet end 18 e—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 32 e that has a circular opening 33 e and a flap valve 34 e as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 35 e that has a circular opening 36 e and a flap valve 37 e as demonstrated by the dotted line. On inhalation, the inhalation flap valve 34 e moves away from the valve seat 32 e for the aerosol particles to move from the MDI chamber 1 e to the patient through the opening 33 e in the valve seat 32 e of the tube 16 e. On exhalation, the flap valve 34 e moves towards the flap valve seat 32 e and closes the opening 33 e to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 1 e thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 32 e prevents any protrusion of the flap valve 34 e through the opening 33 e. The exhalation flap valve assembly has a flap valve 37 e that presses against the flap valve seat 35 e on inhalation and completely occludes the opening 36 e to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 16 e on inhalation. On exhalation the flap valve 37 e moves away from the flap valve seat 35 e for the air exhaled by the patient to escape into the atmosphere from tube 16 e through the opening 36 e.

The nebulizer chamber 4 e has a hollow cylindrical inlet tube 38 e with an inlet end 39 e and an outlet end 40 e. The inlet and 39 e can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. The inlet end 39 e may have a boot adapter assembly to accommodate the boot of any commercially available MDI and the MDI 24 e maybe alternatively be connected to the inlet end 39 e of the tube and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber 4 e to the MDI chamber. The inhaler 24 e has a boot 25 e with an inlet end 26 e and an outlet end 27 e. A canister 28 e is introduced into the boot 25 e through the inlet end 26 e and the nozzle 29 e of the MDI 24 e is attached to an actuator 30 e. The actuator 30 e has an opening or an aperture 31 e. On actuation of the MDI canister 28 e, the medication aerosol particles are generated through the opening 31 e of the actuator 30 e.

The nebulizer chamber has an inlet port 52 e for connection with a standard small volume nebulizer 53 e. The aerosol medication generated with the nebulizer 53 e can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 2 e 6 e. Chamber 4 e also has another inlet 54 e for connection to a reservoir bag 55 e. The reservoir bag 55 e serves to store the aerosol particles generated by the nebulizer 53 e during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 55 e has two small inlets 56 e and 57 e to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 1F is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention. FIG. 1F is a perspective view of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The MDI chamber 1 a has an outlet end 3 f. The nebulizer chamber 4 f has an inlet end 5 f. The inlet end of the MDI chamber 1 f and the outlet end of the nebulizer chamber 4 f are fused together, the point of fusion is labeled as 2 f 6 f. The outlet end 3 f of the MDI chamber 1 f has a hollow cylindrical tube 16 f with an inlet end 17 f and an outlet end 18 f. The MDI chamber 1 f may be made of plastic, paper, or metal. The chamber 1 f may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 19 f and grooves 20 f. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 21 f of the coil are demonstrated in the figure as dotted lines. The chamber 1 f in this figure is demonstrated to be fully or partially collapsed. The distance 22 f and 23 f between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. When fully collapsed, the inlet end 17 f of the tube 16 f may be fused to the outlet end 9 f of the tube 7 f. The distance 22 f and 23 f between the two adjacent ridges, rings of the coil, or grooves may be equal.

The outlet tube 16 f of the MDI chamber 1 f has two valve assemblies disposed between the inlet end 17 f and the outlet end 18 f—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 32 f that has a circular opening 33 f and a flap valve 34 f as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 35 f that has a circular opening 36 f and a flap valve 37 f as demonstrated by the dotted line. On inhalation, the inhalation flap valve 34 f moves away from the valve seat 32 f for the aerosol particles to move from the MDI chamber 1 f to the patient through the opening 33 f in the valve seat 32 f of the tube 16 f. On exhalation, the flap valve 34 f moves towards the flap valve seat 32 f and closes the opening 33 f to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 1 f thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 32 f prevents any protrusion of the flap valve 34 f through the opening 33 f. The exhalation flap valve assembly has a flap valve 37 f that presses against the flap valve seat 35 f on inhalation and completely occludes the opening 36 f to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 16 f on inhalation. On exhalation the flap valve 37 f moves away from the flap valve seat 35 f for the air exhaled by the patient to escape into the atmosphere from tube 16 f through the opening 36 f.

The nebulizer chamber 4 f has a hollow cylindrical inlet tube 38 f with an inlet end 39 f and an outlet end 40 f. The inlet and 39 f can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. The inlet end 39 f may have a boot adapter assembly to accommodate the boot of any commercially available MDI and the MDI 24 f maybe alternatively be connected to the inlet end 39 f of the tube and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber 4 f to the MDI chamber. The inhaler 24 f has a boot 25 f with an inlet end 26 f and an outlet end 27 f. A canister 28 f is introduced into the boot 25 f through the inlet end 26 f and the nozzle 29 f of the MDI 24 f is attached to an actuator 30 f. The actuator 30 f has an opening or an aperture 31 f. On actuation of the MDI canister 28 f, the medication aerosol particles are generated through the opening 31 f of the actuator 30 f.

The nebulizer chamber has an inlet port 52 f for connection with a standard small volume nebulizer 53 f. The aerosol medication generated with the nebulizer 53 f can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 2 f 6 f. Chamber 4 f also has another inlet 54 f for connection a reservoir bag 55 f. The reservoir bag 55 f serves to store the aerosol particles generated by the nebulizer 53 f during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 55 f has two small inlets 56 f and 57 f to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 2A is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the third alternative embodiment of the present invention. FIG. 2A is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber 58 a, and a nebulizer chamber 61 a. The MDI chamber 58 a has an inlet end 59 a and an outlet end 60 a. The nebulizer chamber 61 a similarly has an inlet end 62 a and an outlet end 63 a. The inlet end 59 a has three hollow cylindrical inlet tubes, a central tube 64 a and two peripheral tubes 67 a and 70 a located at three o'clock to nine o'clock positions. The central hollow cylindrical tube 64 a has an inlet end 65 a and an outlet end 66 a. The peripheral tube 67 a has an inlet end 68 a and an outlet end 69 a and the peripheral tube 70 a similarly has an inlet end 71 a and an outlet ed 72 a. The outlet end 60 a of the MDI chamber 58 a has a hollow cylindrical tube 73 a with an inlet end 74 a and an outlet end 75 a. The MDI chamber 58 a may be made of plastic, paper, or metal. The chamber 58 a may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 76 a and grooves 77 a. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 21 a of the coil are demonstrated in the figure as dotted lines. The distance 79 a and 80 a between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber 58 a and the nebulizer chamber 61 a in this figure are illustrated as fully expanded. The inlet end 65 a of the tube 64 a is attached to the outlet end 84 a of the boot 82 a of a metered dose inhaler 81 a. The inhaler 81 a has a boot 82 a with an inlet end 83 a and an outlet end 84 a. A canister 85 a is introduced into the boot 82 a through the inlet end 83 a and the nozzle 86 a of the MDI 81 a is attached to an actuator 87 a. The actuator 87 a has an opening or an aperture 88 a. On actuation of the MDI canister 85 a, the medication aerosol particles are generated through the opening 88 a of the actuator 87 a, and enter into the chamber 58 through the outlet end 66 a of the tube 64 a.

The outlet tube 73 a of the MDI chamber 58 a has two valve assemblies disposed between the inlet end 74 a and the outlet end 75 a—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 89 a that has a circular opening 90 a and a flap valve 91 a as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 92 a that has a circular opening 93 a and a flap valve 94 a as demonstrated by the dotted line. On inhalation, the inhalation flap valve 91 a moves away from the valve seat 89 a for the aerosol particles to move from the MDI chamber 58 a to the patient through the opening 90 a in the valve seat 89 a of the tube 73 a. On exhalation, the flap valve 91 a moves towards the flap valve seat 89 a and closes the opening 90 a to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 58 a thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 89 a prevents any protrusion of the flap valve 91 a through the opening 90 a. The exhalation flap valve assembly has a flap valve 94 a that presses against the flap valve seat 92 a on inhalation and completely occludes the opening 93 a to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 73 a on inhalation. On exhalation the flap valve 94 a moves away from the flap valve seat 92 a for the air exhaled by the patient to escape into the atmosphere from tube 73 a through the opening 93 a.

The nebulizer chamber 61 a has a hollow cylindrical outlet tube 98 a that has an inlet end 99 a and an outlet end 100 a. The outlet end 100 a may remain plugged with a cap when the device is in use with a metered dose inhaler. The nebulizer chamber also has two hollow cylindrical tubes, 101 a and 104 a, at three o'clock and nine o'clock positions. Tube 101 a has an inlet end 102 a and an outlet end 103 a, whereas the tube 104 a has an inlet end 105 a and an outlet end 106 a. The inlet end 68 a of the tube 67 a is connected to the outlet end 103 a of the tube 101 a with a collapsible/expandable stiff corrugated plastic tubing 107 a and similarly the inlet end 71 a of tube 70 a is connected to the outlet end 106 a of tube 104 a with a collapsible/expandable corrugated plastic tubing 108 a. The collapsible/expandable tubings 107 a and 108 a are demonstrated to be fully expanded in FIG. 1A to accommodate MDI boot 82 a between the MDI chamber 1 a and the nebulizer chamber 61 a. The nebulizer chamber has an inlet port 109 a for connection with a standard small volume nebulizer 110 a.

Nebulizer chamber 61 a may have another inlet 11 a for connection to a reservoir bag 112 a. The bag 112 a may have two small inlets 113 a and 114 a to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag 112 a may be replaced by a corrugated plastic reservoir tubing or chamber 115 a that may be connected to inlet 111 a or to the inlet end 62 a of the nebulizer chamber 61 a. The reservoir tubing/chamber 115 a may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 116 a and grooves 117 a. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 118 a of the coil are demonstrated in the figure as dotted lines. The distance 119 a and 120 a between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag 112 a or reservoir tubing 115 a serves to store the aerosol particles generated by the nebulizer 110 a during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end 121 a that may have a hollow cylindrical inlet tube 95 a with an inlet end 96 a and an outlet end 97 a. The inlet and 96 a can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 2B is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the third alternative embodiment of the present invention. FIG. 2B is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber 58 b, and a nebulizer chamber 61 b. The MDI chamber 58 b has an inlet end 59 b and an outlet end 60 b. The nebulizer chamber 61 b similarly has an inlet end 62 b and an outlet end 63 b. The inlet end 59 b has three hollow cylindrical inlet tubes, a central tube 64 b and two peripheral tubes 67 b and 70 b located at three o'clock to nine o'clock positions. The central hollow cylindrical tube 64 b has an inlet end 65 b and an outlet end 66 b The peripheral tube 67 b has an inlet end 68 b and an outlet end 69 b and the peripheral tube 70 b similarly has an inlet end 71 b and an outlet ed 72 b. The outlet end 60 b of the MDI chamber 58 b has a hollow cylindrical tube 73 b with an inlet end 74 b and an outlet end 75 b. The MDI chamber 58 b may be made of plastic, paper, or metal. The chamber 58 b may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 76 b and grooves 77 b. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 78 b of the coil are demonstrated in the figure as dotted lines. The chamber in this figure is demonstrated to be fully or partially collapsed. The distance 79 b and 80 b between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. When fully collapsed, the inlet end 74 b of the tube 73 b may be fused to the outlet end 66 b of the tube 64 b. The distance 79 a and 80 a between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber 58 b and the nebulizer chamber 61 b in this figure are illustrated as fully or partially collapsed. The inlet end 65 b of the tube 64 b is attached to the outlet end 84 b of the boot 82 b of a metered dose inhaler 81 b. The inhaler 81 b has a boot 82 b with an inlet end 83 b and an outlet end 84 b. A canister 85 b is introduced into the boot 82 b through the inlet end 83 b and the nozzle 86 b of the MDI 81 b is attached to an actuator 87 b. The actuator 87 b has an opening or an aperture 88 b. On actuation of the MDI canister 85 b, the medication aerosol particles are generated through the opening 88 b of the actuator 87 b, and enter into the chamber 58 through the outlet end 66 b of the tube 64 b.

The outlet tube 73 b of the MDI chamber 58 b has two valve assemblies disposed between the inlet end 74 b and the outlet end 75 b—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 89 b that has a circular opening 90 b and a flap valve 91 b as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 92 b that has a circular opening 93 b and a flap valve 94 b as demonstrated by the dotted line. On inhalation, the inhalation flap valve 91 b moves away from the valve seat 89 b for the aerosol particles to move from the MDI chamber 58 b to the patient through the opening 90 b in the valve seat 89 b of the tube 73 b. On exhalation, the flap valve 91 b moves towards the flap valve seat 89 b and closes the opening 90 b to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 58 b thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 89 b prevents any protrusion of the flap valve 91 b through the opening 90 b. The exhalation flap valve assembly has a flap valve 94 b that presses against the flap valve seat 92 b on inhalation and completely occludes the opening 93 b to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 73 b on inhalation. On exhalation the flap valve 94 b moves away from the flap valve seat 92 b for the air exhaled by the patient to escape into the atmosphere from tube 73 b through the opening 93 b. The nebulizer chamber 61 b has a hollow cylindrical inlet tube 95 b with an inlet end 96 b and an outlet end 97 b. The inlet and 96 b can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The nebulizer chamber 61 b has a hollow cylindrical outlet tube 98 b that has an inlet end 99 b and an outlet end 100 b. The outlet end 100 b may remain plugged with a cap when the device is in use with a metered dose inhaler. The nebulizer chamber also has two hollow cylindrical tubes, 101 b and 104 b, at three o'clock and nine o'clock positions. Tube 101 b has an inlet end 102 b and an outlet end 103 b, whereas the tube 104 b has an inlet end 105 b and an outlet end 106 b. The inlet end 68 b of the tube 67 b is connected to the outlet end 103 b of the tube 101 b with a collapsible/expandable stiff corrugated plastic tubing 107 b and similarly the inlet end 71 b of tube 70 b is connected to the outlet end 106 b of tube 104 b with a collapsible/expandable corrugated plastic tubing 108 b. The collapsible/expandable tubings 107 b and 108 b are demonstrated to be fully expanded in FIG. 1A to accommodate MDI boot 82 b between the MDI chamber 1 b and the nebulizer chamber 61 b. The nebulizer chamber has an inlet port 109 a for connection with a standard small volume nebulizer 110 b.

Nebulizer chamber 61 b may have another inlet 111 b for connection to a reservoir bag 112 b. The bag 112 b may have two small inlets 113 b and 114 b to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag 112 b may be replaced by a corrugated plastic reservoir tubing/chamber 115 b that may be connected to inlet 111 b or to the inlet end 62 b of the nebulizer chamber 61 b. The reservoir tubing/chamber 115 b may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 116 b and grooves 117 b. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 118 b of the coil are demonstrated in the figure as dotted lines. The distance 119 b and 120 b between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag 112 b or reservoir tubing 115 b serves to store the aerosol particles generated by the nebulizer 110 b during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end 121 b that may have a hollow cylindrical inlet tube 95 b with an inlet end 96 b and an outlet end 97 b. The inlet and 96 b can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 2C is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the fourth alternative embodiment of the present invention. FIG. 2C is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber 58 c, and a nebulizer chamber 61 c. The MDI chamber 58 c has an inlet end 59 c and an outlet end 60 c. The nebulizer chamber 61 c similarly has an inlet end 62 c and an outlet end 63 c. The inlet end 59 c has three hollow cylindrical inlet tubes, a central tube 64 c and two peripheral tubes 67 c and 70 c located at three o'clock to nine o'clock positions. The central hollow cylindrical tube 64 c has an inlet end 65 c and an outlet end 66 c The peripheral tube 67 c has an inlet end 68 c and an outlet end 69 c and the peripheral tube 70 c similarly has an inlet end 71 c and an outlet ed 72 c. The outlet end 60 c of the MDI chamber 58 c has a hollow cylindrical tube 73 c with an inlet end 74 c and an outlet end 75 c. The MDI chamber 58 c may be made of plastic, paper, or metal. The chamber 58 c may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 76 c and grooves 77 c. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 78 c of the coil are demonstrated in the figure as dotted lines. The distance 79 c and 80 c between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber 58 c and the nebulizer chamber 61 c in this figure are illustrated as fully expanded. The inlet end 65 c of the tube 64 c is not attached to the MDI 81 c as demonstrated in FIG. 1A. The MDI 81 c is demonstrated separately in this figure. The inhaler 81 c has a boot 82 c with an inlet end 83 c and an outlet end 84 c. A canister 85 c is introduced into the boot 82 c through the inlet end 83 c and the nozzle 86 c of the MDI 81 c is attached to an actuator 87 c. The actuator 87 c has an opening or an aperture 88 c. On actuation of the MDI canister 85 c, the medication aerosol particles are generated through the opening 88 c of the actuator 87 c.

The outlet tube 73 c of the MDI chamber 58 a has two valve assemblies disposed between the inlet end 74 c and the outlet end 75 c—the inhalation valve assembly and an exhalation valve assembly The inhalation flap valve assembly has a circular flap valve seat 89 c that has a circular opening 90 c and a flap valve 91 c as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 92 c that has a circular opening 93 c and a flap valve 94 c as demonstrated by the dotted line. On inhalation, the inhalation flap valve 91 c moves away from the valve seat 89 c for the aerosol particles to move from the MDI chamber 58 c to the patient through the opening 90 c in the valve seat 89 c of the tube 73 c. On exhalation, the flap valve 91 c moves towards the flap valve seat 89 c and closes the opening 90 c to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 58 c thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 89 c prevents any protrusion of the flap valve 91 c through the opening 90 c. The exhalation flap valve assembly has a flap valve 94 c that presses against the flap valve seat 92 c on inhalation and completely occludes the opening 93 c to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 73 c on inhalation. On exhalation the flap valve 94 c moves away from the flap valve seat 92 c for the air exhaled by the patient to escape into the atmosphere from tube 73 c through the opening 93 c. The nebulizer chamber 61 c has a hollow cylindrical inlet tube 95 c with an inlet end 96 c and an outlet end 97 c. The inlet and 96 c can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The nebulizer chamber 61 c has a hollow cylindrical outlet tube 98 c that has an inlet end 99 c and an outlet end 100 c. The nebulizer chamber also has two hollow cylindrical tubes, 101 c and 104 c, at three o'clock and nine o'clock positions. Tube 101 c has an inlet end 102 c and an outlet end 103 c, whereas the tube 104 c has an inlet end 105 c and an outlet end 106 c. The inlet end 68 c of the tube 67 c is connected to the outlet end 103 c of the tube 101 c with a collapsible/expandable stiff corrugated plastic tubing 107 c and similarly the inlet end 71 c of tube 70 c is connected to the outlet end 106 c of tube 104 c with a collapsible/expandable corrugated plastic tubing 108 c. Quite unlike FIG. 2A the collapsible/expandable tubings 107 c and 108 c are now demonstrated to be collapsed but still fully patent. The inlet end 66 c of the tube 64 c is now fused to the outlet end 100 c of the tube 98 c. The inlet ends 68 c and 71 c may be fused to the outlet ends 103 c and 106 c respectively or may stay separated. The nebulizer chamber has an inlet port 109 c for connection with a standard small volume nebulizer 110 c. The aerosol medication generated with the nebulizer 110 c can enter the MDI chamber via a central connection between the tubes 60 c and 98 c or through the peripheral connections between the tubes 67 c and 101 c, and 70 c and 104 c.

Nebulizer chamber 61 c may have another inlet 111 c for connection to a reservoir bag 112 c. The bag 112 c may have two small inlets 113 c and 114 c to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag 112 c may be replaced by a corrugated plastic reservoir tubing/chmaber 115 c that may be connected to inlet 111 c or to the inlet end 62 c of the nebulizer chamber 61 c. The reservoir tubing/chamber 115 c may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 116 c and grooves 117 c. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 118 c of the coil are demonstrated in the figure as dotted lines. The distance 119 c and 120 c between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag 112 c or reservoir tubing 115 c serves to store the aerosol particles generated by the nebulizer 110 c during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end 121 c that may have a hollow cylindrical inlet tube 95 c with an inlet end 96 c and an outlet end 97 c. The inlet end 96 c can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI 81 c can be connected to the inlet 97 c and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber 61 c to the MDI chamber 58 c via the central and two peripheral connections between the two chambers as described before. On actuation of the MDI canister 85 c, the medication aerosol particles are generated through the opening 88 c of the actuator 87 c, and enter into the chamber 58 through the outlet end 66 c of the tube 64 c.

FIG. 2D is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the fourth alternative embodiment of the present invention. FIG. 2D is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber 58 d, and a nebulizer chamber 61 d. The MDI chamber 58 d has an inlet end 59 d and an outlet end 60 d. The nebulizer chamber 61 d similarly has an inlet end 62 d and an outlet end 63 d. The inlet end 59 d has three hollow cylindrical inlet tubes, a central tube 64 d and two peripheral tubes 67 d and 70 d located at three o'clock to nine o'clock positions. The central hollow cylindrical tube 64 d has an inlet end 65 d and an outlet end 66 d. The peripheral tube 67 d has an inlet end 68 d and an outlet end 69 d and the peripheral tube 70 d similarly has an inlet end 71 d and an outlet end 72 d. The outlet end 60 d of the MDI chamber 58 d has a hollow cylindrical tube 73 d with an inlet end 74 d and an outlet end 75 d. The MDI chamber 58 d may be made of plastic, paper, or metal. The chamber 58 d may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 76 d and grooves 77 d. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 78 d of the coil are demonstrated in the figure as dotted lines. The chamber in this figure is demonstrated to be fully or partially collapsed. The distance 79 d and 80 d between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. The MDI chamber 58 d and the nebulizer chamber 61 d in this figure are illustrated as fully collapsed. When fully collapsed, the inlet end 74 d of the tube 73 d may be fused to the outlet end 66 d of the tube 64 d. The distance 79 d and 80 d between the two adjacent ridges, rings of the coil, or grooves may be equal. The inlet end 65 d of the tube 64 a is not attached to the MDI 81 d as demonstrated in FIG. 1A. The MDI 81 d is demonstrated separately in this figure. The inhaler 81 d has a boot 82 d with an inlet end 83 d and an outlet end 84 d. A canister 85 d is introduced into the boot 82 d through the inlet end 83 d and the nozzle 86 d of the MDI 81 d is attached to an actuator 87 d. The actuator 87 d has an opening or an aperture 88 d. On actuation of the MDI canister 85 d, the medication aerosol particles are generated through the opening 88 ad of the actuator 87 d.

The outlet tube 73 d of the MDI chamber 58 d has two valve assemblies disposed between the inlet end 74 d and the outlet end 75 d—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 89 d that has a circular opening 90 d and a flap valve 91 d as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 92 d that has a circular opening 93 d and a flap valve 94 d as demonstrated by the dotted line. On inhalation, the inhalation flap valve 91 d moves away from the valve seat 89 d for the aerosol particles to move from the MDI chamber 58 d to the patient through the opening 90 d in the valve seat 89 d of the tube 73 d. On exhalation, the flap valve 91 d moves towards the flap valve seat 89 d and closes the opening 90 d to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 58 d thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 89 d prevents any protrusion of the flap valve 91 d through the opening 90 d. The exhalation flap valve assembly has a flap valve 94 d that presses against the flap valve seat 92 d on inhalation and completely occludes the opening 93 d to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 73 d on inhalation. On exhalation the flap valve 94 d moves away from the flap valve seat 92 d for the air exhaled by the patient to escape into the atmosphere from tube 73 d through the opening 93 d.

The nebulizer chamber 61 d has a hollow cylindrical inlet tube 95 d with an inlet end 96 d and an outlet end 97 d. The inlet and 96 d can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber 61 d has a hollow cylindrical outlet tube 98 d that has an inlet end 99 d and an outlet end 100 d. The nebulizer chamber also has two hollow cylindrical tubes, 101 d and 104 d, at three o'clock and nine o'clock positions. Tube 101 d has an inlet end 102 d and an outlet end 103 d, whereas the tube 104 d has an inlet end 105 d and an outlet end 106 d. The inlet end 68 d of the tube 67 d is connected to the outlet end 103 d of the tube 101 d with a collapsible/expandable stiff corrugated plastic tubing 107 d and similarly the inlet end 71 d of tube 70 d is connected to the outlet end 106 d of tube 104 d with a collapsible/expandable corrugated plastic tubing 108 d. Quite unlike FIG. 2A the collapsible/expandable tubings 107 d and 108 d are now demonstrated to be collapsed but still fully patent. The inlet end 66 d of the tube 64 d is now fused to the outlet end 100 d of the tube 98 d. The inlet ends 68 d and 71 d may be fused to the outlet ends 103 d and 106 d respectively or may stay separated. The nebulizer chamber has an inlet port 109 d for connection with a standard small volume nebulizer 110 d. The aerosol medication generated with the nebulizer 110 d can enter the MDI chamber via a central connection between the tubes 60 d and 98 d or through the peripheral connections between the tubes 67 d and 101 d, and 70 d and 104 d.

Nebulizer chamber 61 d may have another inlet 111 d for connection to a reservoir bag 112 d. The bag 112 d may have two small inlets 113 d and 114 d to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag 112 d may be replaced by a corrugated plastic reservoir tubing/chamber 115 d that may be connected to inlet 111 d or to the inlet end 62 d of the nebulizer chamber 61 d. The reservoir tubing/chamber 115 d may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 116 d and grooves 117 d. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 118 d of the coil are demonstrated in the figure as dotted lines. The distance 119 d and 120 d between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag 112 d or reservoir tubing 115 d serves to store the aerosol particles generated by the nebulizer 110 d during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end 121 d that may have a hollow cylindrical inlet tube 95 d with an inlet end 96 d and an outlet end 97 d. The inlet and 96 d can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI 81 d can be connected to the inlet 97 d and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber 61 d to the MDI chamber 58 d via the central and two peripheral connections between the two chambers as described before. On actuation of the MDI canister 85 d, the medication aerosol particles are generated through the opening 88 d of the actuator 87 d, and enter into the chamber 58 through the outlet end 66 d of the tube 64 d.

FIG. 2E is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the fifth alternative embodiment of the present invention. FIG. 2E is a plan view of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The MDI chamber 58 e has an outlet end 60 e. The nebulizer chamber 61 e has an inlet end 62 e. The inlet end of the MDI chamber 58 e and the outlet end of the nebulizer chamber 4 e are fused together, the point of fusion is labeled as 2 e 6 e. The outlet end 60 e of the MDI chamber 1 e has a hollow cylindrical tube 73 e with an inlet end 74 e and an outlet end 75 e. The MDI chamber 1 e may be made of plastic, paper, or metal. The chamber 1 e may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 76 e and grooves 77. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 78 e of the coil are demonstrated in the figure as dotted lines. The distance 79 e and 80 e between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber 58 e and the nebulizer chamber 61 e in this figure are illustrated as fully expanded.

The outlet tube 73 e of the MDI chamber 58 e has two valve assemblies disposed between the inlet end 74 e and the outlet end 75 e—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 89 e that has a circular opening 90 e and a flap valve 91 e as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 92 e that has a circular opening 93 e and a flap valve 94 e as demonstrated by the dotted line. On inhalation, the inhalation flap valve 91 e moves away from the valve seat 89 e for the aerosol particles to move from the MDI chamber 58 e to the patient through the opening 90 e in the valve seat 89 e of the tube 73 e. On exhalation, the flap valve 91 e moves towards the flap valve seat 89 e and closes the opening 90 e to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 58 e thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 89 e prevents any protrusion of the flap valve 91 e through the opening 90 e. The exhalation flap valve assembly has a flap valve 94 e that presses against the flap valve seat 92 e on inhalation and completely occludes the opening 93 e to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 73 e on inhalation. On exhalation the flap valve 94 e moves away from the flap valve seat 92 e for the air exhaled by the patient to escape into the atmosphere from tube 73 e through the opening 93 e.

The nebulizer chamber 61 e has a hollow cylindrical inlet tube 95 e with an inlet end 96 e and an outlet end 97 a. The inlet and 96 e can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. The inlet end 96 e may have a boot adapter assembly to accommodate the boot of any commercially available MDI and the MDI 81 e maybe alternatively be connected to the inlet end 96 e of the tube and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber 61 e to the MDI chamber. The inhaler 81 e has a boot 82 e with an inlet end 83 e and an outlet end 84 e. A canister 85 e is introduced into the boot 82 e through the inlet end 83 e and the nozzle 86 e of the MDI 81 a is attached to an actuator 87 e. The actuator 87 e has an opening or an aperture 88 e. On actuation of the MDI canister 85 e, the medication aerosol particles are generated through the opening 88 e of the actuator 87 e.

The nebulizer chamber has an inlet port 109 e for connection with a standard small volume nebulizer 110 e. The aerosol medication generated with the nebulizer 110 e can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 59 e 63 e. Nebulizer chamber 61 e may have another inlet 111 e for connection to a reservoir bag 112 e. The bag 112 e may have two small inlets 113 e and 114 e to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag 112 e may be replaced by a corrugated plastic reservoir tubing/chamber 115 e that may be connected to inlet 111 e or to the inlet end 62 e of the nebulizer chamber 61 e. The reservoir tubing/chamber 115 e may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 116 e and grooves 117 e. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 118 e of the coil are demonstrated in the figure as dotted lines. The distance 119 e and 120 e between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag 112 e or reservoir tubing 115 e serves to store the aerosol particles generated by the nebulizer 110 e during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end 121 e that may have a hollow cylindrical inlet tube 95 e with an inlet end 96 a and an outlet end 97 e. The inlet end 96 e can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The MDI 81 e can be connected to the inlet 97 e and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber 61 e to the MDI chamber 58 e via the central and two peripheral connections between the two chambers as described before. On actuation of the MDI canister 85 e, the medication aerosol particles are generated through the opening 88 e of the actuator 87 e, and enter into the chamber 58 e through the outlet end 66 e of the tube 64 e.

FIG. 2F is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the fifth alternative embodiment of the present invention. FIG. 2F is a plan view of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The MDI chamber 58 f has an outlet end 60 f. The nebulizer chamber 61 f has an inlet end 62 f. The inlet end of the MDI chamber 58 f and the outlet end of the nebulizer chamber 4 f are fused together, the point of fusion is labeled as 2 f 6 f. The outlet end 60 f of the MDI chamber 1 f has a hollow cylindrical tube 73 f with an inlet end 74 f and an outlet end 75 f. The MDI chamber 1 f may be made of plastic, paper, or metal. The chamber 1 f may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 76 f and grooves 77. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 78 f of the coil are demonstrated in the figure as dotted lines. The chamber in this figure is demonstrated to be fully or partially collapsed. The distance 79 f and 80 f between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. The MDI chamber 58 f and the nebulizer chamber 61 f in this figure are illustrated as fully collapsed. When fully collapsed, the inlet end 74 f of the tube 73 f may be fused to the outlet end 66 f of the tube 64 f. The distance 79 f and 80 f between the two adjacent ridges, rings of the coil, or grooves may be equal.

The outlet tube 73 f of the MDI chamber 58 f has two valve assemblies disposed between the inlet end 74 f and the outlet end 75 f—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 89 f that has a circular opening 90 f and a flap valve 91 f as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 92 f that has a circular opening 93 f and a flap valve 94 f as demonstrated by the dotted line. On inhalation, the inhalation flap valve 91 f moves away from the valve seat 89 f for the aerosol particles to move from the MDI chamber 58 f to the patient through the opening 90 f in the valve seat 89 f of the tube 73 f. On exhalation, the flap valve 91 f moves towards the flap valve seat 89 f and closes the opening 90 f to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 58 f thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 89 f prevents any protrusion of the flap valve 91 f through the opening 90 f. The exhalation flap valve assembly has a flap valve 94 f that presses against the flap valve seat 92 f on inhalation and completely occludes the opening 93 f to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 73 f on inhalation. On exhalation the flap valve 94 f moves away from the flap valve seat 92 f for the air exhaled by the patient to escape into the atmosphere from tube 73 f through the opening 93 f.

The nebulizer chamber 61 f has a hollow cylindrical inlet tube 95 f with an inlet end 96 f and an outlet end 97 f. The inlet and 96 f can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. The inlet end 96 f may have a boot adapter assembly to accommodate the boot of any commercially available MDI and the MDI 81 f maybe alternatively be connected to the inlet end 96 f of the tube and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber 61 f to the MDI chamber. The inhaler 81 f has a boot 82 f with an inlet end 83 f and an outlet end 84 f. A canister 85 f is introduced into the boot 82 f through the inlet end 83 f and the nozzle 86 f of the MDI 81 f is attached to an actuator 87 f. The actuator 87 f has an opening or an aperture 88 f. On actuation of the MDI canister 85 f, the medication aerosol particles are generated through the opening 88 f of the actuator 87 f.

The nebulizer chamber has an inlet port 109 f for connection with a standard small volume nebulizer 110 f. The aerosol medication generated with the nebulizer 110 f can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 59 f 63 f. Nebulizer chamber 61 f may have another inlet 111 f for connection to a reservoir bag 112 f. The bag 112 f may have two small inlets 113 f and 114 f to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag 112 f may be replaced by a corrugated plastic reservoir tubing/chamber 115 f that may be connected to inlet 111 f or to the inlet end 62 f of the nebulizer chamber 61 f. The reservoir tubing/chamber 115 f may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 116 f and grooves 117 f. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 118 f of the coil are demonstrated in the figure as dotted lines. The distance 119 f and 120 f between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag 112 f or reservoir tubing 115 f serves to store the aerosol particles generated by the nebulizer 110 f during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end 121 f that may have a hollow cylindrical inlet tube 95 f with an inlet end 96 f and an outlet end 97 f. The inlet and 96 f can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The MDI 81 f can be connected to the inlet 97 f and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber 61 f to the MDI chamber 58 f via the central and two peripheral connections between the two chambers as described before. On actuation of the MDI canister 85 f, the medication aerosol particles are generated through the opening 88 f of the actuator 87 f, and enter into the chamber 58 through the outlet end 66 f of the tube 64 f.

FIGS. 3A,3B,3C,3D,3E, and 3F are the plan views of the MDI chamber 1 a as described in FIG. 1A. They also represent the plan views of the reservoir tubing or chamber 115 a as described in FIG. 2A. The MDI chamber/reservoir chamber may be made of plastic, paper, or metal. The chamber(s) may be a fixed volume chamber or a collapsible/expandable chamber. The chamber(s) may have a uniform diameter throughout it's length or alternatively the diameter of the chamber may be uniform for a fixed portion of the total length of the chamber and then change to a different diameter for the rest of it's length. The chamber(s) may be cylindrical with smooth edges or cylindrical with multiple ridges and grooves. The chamber(s) may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber(s) may be supported with a metal or plastic coil with multiple rings. The distance and between the two adjacent ridges, rings of the coil, or grooves may be equal.

FIG. 3A is an expanded plan view of MDI chamber 1 a according to the present invention as described in FIG. 1A. FIG. 3A is an expanded plan view of the MDI chamber 1 a as described in FIG. 1A. It is also an expanded plan view of the reservoir tubing or chamber 115 a as described in FIG. 2A. The MDI chamber/reservoir chamber 122 a may be made of plastic, paper, or metal. The chamber(s) may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end 123 a and an outlet end 124 a. The chamber(s) has a uniform diameter throughout its length and is cylindrical in shape. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The MDI chamber 122 a in this figure is illustrated as fully expanded. The multiple rings 125 a of the coil are demonstrated in the figure as dotted lines. The distance between the two adjacent rings of the coil 126 a and 127 a may be equal.

FIG. 3B is an expanded plan views of MDI chamber 1 a according to the present invention as described in FIG. 1A. FIG. 3B is an expanded plan view of the MDI chamber/reservoir chamber 122 a as described in FIG. 3A. The chamber(s) 122 b is a collapsible/expandable chamber. The chamber has an inlet end 123 b and an outlet end 124 b. The chamber(s) has a uniform diameter throughout it's length and is cylindrical in shape. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable. The MDI chamber 122 b in this figure is illustrated as fully or partially collapsed. The multiple rings 125 b of the coil are demonstrated in the figure as dotted lines. The chamber as is demonstrated here may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together. The distance between the two adjacent rings of the coil 126 b and 127 b may be equal.

FIG. 3C is an expanded plan view of MDI chamber 1 a according the first alternative embodiment of the present invention as described in FIG. 3A and FIG. 3B. FIG. 3C is an expanded plan view of the MDI chamber/reservoir chamber 122 a as described in FIG. 3A. The chamber(s) 122 c may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end 123 c and an outlet end 124 c. The chamber(s) is cylindrical in shape but does not have a uniform diameter throughout it's length as described in FIG. 3A. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The MDI chamber 122 c in this figure is illustrated as fully expanded The multiple rings 125 c of the coil are demonstrated in the figure as dotted lines. The diameter of the chamber for a portion of the length 126 c of the chamber is different from the diameter of a portion of the length 127 c of the chamber. The diameter of the rings 128 c that support a portion of the length 126 c of the chamber is different from the diameter of the rings 129 c that support a portion of the length 127 c of the chamber. The distance between the two adjacent rings of the coil 130 c and 131 c may be equal. Similarly the distance between the two adjacent rings of the coil 132 c and 133 c may be equal. The multiple rings 125 c of the coil are demonstrated in the figure as dotted lines. The chamber here is demonstrated to be fully expanded but it may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together.

FIG. 3D is and expanded plan view of MDI chamber 1 a according to the second alternative embodiment of the present invention as described in FIGS. 3A and 3B. FIG. 3D is a perspective view of the MDI chamber 1 a as described in FIG. 1A. It is also a perspective view of the reservoir tubing or chamber 115 a as described in FIG. 2A. The MDI chamber/reservoir chamber 122 d may be made of plastic, paper, or metal. The chamber(s) may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end 123 d and an outlet end 124 d. The chamber(s) has a uniform diameter throughout it's length, is cylindrical in shape with multiple ridges and grooves throughout the length of the chamber. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The MDI chamber 122 d in this figure is illustrated as fully expanded. The multiple rings 125 d of the coil are demonstrated in the figure as dotted lines. The distance and between the two adjacent rings of the coil 126 d and 127 d may be equal.

FIG. 3E is an expanded plan view of MDI chamber 1 a according to the second alternative embodiment of the present invention as described in FIGS. 3A and 3B. FIG. 3E is an expanded plan view of the MDI chamber/reservoir chamber 122 d as described in FIG. 3D. The chamber(s) 122 e is a collapsible/expandable chamber. The chamber has an inlet end 123 e and an outlet end 124 e. The chamber(s) has a uniform diameter throughout it's length and is cylindrical in shape. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable. The MDI chamber 122 e in this figure is illustrated as fully or partially collapsed. The multiple rings 125 e of the coil are demonstrated in the figure as dotted lines. The chamber may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together as has been demonstrated in this figure. The distance 126 e and 127 e between the two adjacent rings of the coil, the ridges, or the grooves may be equal.

FIG. 3F is an expanded plan view of MDI chamber 1 a according to the third alternative embodiment of the present invention as described in FIGS. 3A and 3B. FIG. 3F is an expanded plan view of the MDI chamber/reservoir chamber 122 d as described in FIG. 3D. The chamber(s) 122 f may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end 123 f and an outlet end 124 f. The chamber(s) is cylindrical in shape but does not have a uniform diameter throughout it's length as described in FIG. 3D. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The MDI chamber 122 f in this figure is illustrated as fully expanded The multiple rings 125 f of the coil are demonstrated in the figure as dotted lines. The diameter of the chamber for a portion of the length 126 f of the chamber is different from the diameter of a portion of the length 127 f of the chamber. The diameter of the rings 128 f that support a portion of the length 126 f of the chamber is different from the diameter of the rings 129 f that support a portion of the length 127 f of the chamber. The distance and between the two adjacent rings of the coil 130 f and 131 f may be equal. Similarly the distance and between the two adjacent rings of the coil 132 f and 133 f may be equal. The multiple rings 125 f of the coil are demonstrated in the figure as dotted lines. The chamber here is demonstrated to be fully expanded but it may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together.

FIG. 3G is an expanded plan view of MDI chamber 1 a according to the fourth alternative embodiment of the present invention as described in FIGS. 3A and 3B. FIG. 3G is an expanded plan view of the MDI chamber 1 a as described in FIG. 1A. It is also an alternative plan view of the reservoir tubing or chamber 115 a as described in FIG. 2A. The MDI chamber/reservoir chamber 122 g may be made of plastic, paper, or metal. The chamber(s) may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end 123 a and an outlet end 124 g. The chamber(s) has a uniform diameter throughout it's length, is cylindrical in shape with multiple ridges and grooves throughout the length of the chamber. Quite unlike FIG. 3D, the chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber. The MDI chamber 122 g in this figure is illustrated as fully expanded The distance between the two adjacent ridges or grooves 126 g and 127 g of the corrugated plastic tubing may be equal.

FIG. 3H is an expanded plan views of MDI chamber 1 a according to the fourth alternative embodiment of the present invention as described in FIGS. 3A and 3B. FIG. 3H is an expanded plan view of the MDI chamber/reservoir chamber 122 g as described in FIG. 3G. The chamber(s) 122 h is a collapsible/expandable chamber. The chamber has an inlet end 123 h and an outlet end 124 h. The chamber(s) has a uniform diameter throughout it's length, is cylindrical in shape with multiple ridges and grooves throughout the length of the chamber. The chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber. The MDI chamber 122 h in this figure is illustrated as fully or partially collapsed. The distance 126 h and 127 h between the two adjacent ridges/grooves of the corrugated plastic tubing may be equal.

FIG. 3I is an expanded plan view of MDI chamber 1 a according to the fifth alternative embodiment of the present invention as described in FIGS. 3A and 3B. FIG. 3I is an expanded plan view of the MDI chamber/reservoir chamber 122 g as described in FIG. 3G. The chamber(s) 122 i may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end 123 i and an outlet end 124 i The chamber(s) is cylindrical in shape but quite unlike the description in FIG. 3G, the chamber in FIG. 3I does not have a uniform diameter throughout it's length. The chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber. The MDI chamber 122 i in this figure is illustrated as fully expanded The diameter of the chamber for a portion of the length 126 i of the chamber is different from the diameter of a portion of the length 127 i of the chamber. The diameter of the ridges/grooves 128 i of a portion of the length 126 i of the chamber is different from the diameter of the ridges/grooves 129 i of a portion of the length 127 i of the chamber. The distance between the two adjacent ridges/grooves of the tubing 130 i and 131 i may be equal. Similarly the distance between the two adjacent ridges/grooves of the tubing 132 i and 133 i may be equal. The chamber here is demonstrated to be fully expanded but it may be partially collapsed by pulling some of the ridges/grooves of the tubing together or fully collapsed by pulling all of the ridges/grooves of the tubing together.

FIGS. 4A,4B,4C,4D,4E, and 4F are expanded plan views of the collapsible/expandable tubings 50 a and 51 a as described in FIG. 1A that connect the peripheral tubes at 3 and 9 o'clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o'clock positions in the outlet of the nebulizer chamber. The tubing illustrated here may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. The chamber(s) has a uniform diameter throughout it's length, is cylindrical with smooth edges or cylindrical in shape and made of stiff corrugated plastic material with multiple ridges and grooves. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber(s) may be supported with a metal or plastic coil with multiple rings. The distance and between the two adjacent ridges, rings of the coil, or grooves may be equal.

FIG. 4A is an expanded plan view of tubes 50 a or 51 a according to the present invention as described in FIG. 1A. FIG. 4A is an expanded plan view of the collapsible/expandable tubings 50 a and 51 a as described in FIG. 1A that connects the peripheral tubes at 3 and 9 o'clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o'clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as 134 a may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. The chamber(s) has a uniform diameter throughout it's length, is cylindrical in shape with smooth edges. The chamber may be supported with a metal or plastic coil with multiple rings. The tubing 134 a in this figure is illustrated as fully expanded The distance between the two adjacent rings of the coil may be equal. The chamber 134 a connects the two hollow cylindrical tubes 135 a and 138 a. Tube 135 a represents the expanded view of the tubes 10 a and 13 a and tube 138 a represents the expanded view of the tubes 44 a and 47 a as shown in FIG. 1A. Tube 135 a has an inlet end 136 a and an outlet end 137 a. Tube 138 a has an inlet end 139 a and an outlet end 140 a. The points of attachments of the tubing 134 a to the tube 135 a is between the inlet 136 a and outlet 137 a and is demonstrated in the figure as 141 a. The points of attachments of the tubing 134 a to the tube 138 is between the inlet 139 and outlet 140 a and is demonstrated in the figure as 142 a. The multiple rings 143 a of the coil are demonstrated in the figure as dotted lines. The distance and between the two adjacent rings of the coil 144 a and 145 a may be equal.

FIG. 4B is an expanded plan view of tubes 50 a or 51 a according to the present invention as described in FIG. 1A. FIG. 4B is an expanded plan view of the collapsible/expandable tubings 50 a and 51 a as described in FIG. 1A that connect the peripheral tubes at 3 and 9 o'clock positions in the inlet of the MDI chamber to the peripheral tubes at 3 and 9 o'clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as 134 b may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. In this figure the tubing 134 b is demonstrated as partially or fully collapsed. The chamber(s) has a uniform diameter throughout it's length, is cylindrical in shape with smooth edges. The chamber may be supported with a metal or plastic coil with multiple rings. The tubing 134 b in this figure is illustrated as fully or partially collapsed. The distance and between the two adjacent ridges, rings of the coil, or grooves may be equal. The chamber or tubing 134 b connects the two hollow cylindrical tubes 135 b and 138 b. Tube 135 b represents the expanded view of the tubes 10 a and 13 a and tube 138 b represents the expanded view of the tubes 44 a and 47 a as shown in FIG. 1A. Tube 135 b has an inlet end 136 b and an outlet end 137 b. Tube 138 b has an inlet end 139 b and an outlet end 140 b. The points of attachments of the tubing 134 b to the tube 135 b is between the inlet 136 b and outlet 137 b and is demonstrated in the figure as 141 b. The points of attachments of the tubing 134 b to the tube 138 b is between the inlet 139 b and outlet 140 b and is demonstrated in the figure as 142 b. The multiple rings 143 b of the coil are demonstrated in the figure as dotted lines. The chamber may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together as has been demonstrated in this figure. The distance between the two adjacent rings of the coil 144 b and 145 b may or may not be equal when partially collapsed. When fully collapsed, the inlet end 136 b of the tube 135 b may fuse or mate with the outlet end 140 b of the outlet tube 138 b as has been demonstrated in this figure.

FIG. 4C is an expanded plan view of tubes 50 a or 51 a according to the first alternative embodiment of the present invention as described in FIGS. 4A and 4B. FIG. 4C is an expanded plan_view of the collapsible/expandable tubings 50 a and 51 a as described in FIG. 1A that connect the peripheral tubes at 3 and 9 o'clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o'clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as 134 c may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. The tubing 134 c in this figure is illustrated as fully expanded The chamber(s) has a uniform diameter throughout it's length, is cylindrical in shape with multiple ridges 146 c and grooves 147 c throughout the length of the chamber. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The chamber 134 c connects the two hollow cylindrical tubes 135 c and 138 c. Tube 135 c represents the expanded view of the tubes 10 a and 13 a and tube 138 c represents the expanded view of the tubes 44 a and 47 a as shown in FIG. 1A. Tube 135 c has an inlet end 136 c and an outlet end 137 c. Tube 138 c has an inlet end 139 c and an outlet end 140 c. The points of attachments of the tubing 134 c to the tube 135 c is between the inlet 136 c and outlet 137 c and is demonstrated in the figure as 141 c. The points of attachments of the tubing 134 c to the tube 138 c is between the inlet 139 c and outlet 140 c and is demonstrated in the figure as 142 c. The multiple rings 143 c of the coil are demonstrated in the figure as dotted lines. The distance 144 c and 145 c between the two adjacent rings of the coil 143 c, the ridges 146 c or the grooves 147 c may be equal.

FIG. 4D is an expanded plan view of tubes 50 a or 51 a according to the first alternative embodiment of the present invention as described in FIGS. 4A and 4B. FIG. 4D is an expanded plan_view of the collapsible/expandable tubings 50 a and 51 as described in FIG. 1A that connect the peripheral tubes at 3 and 9 o'clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o'clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as 134 d may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. In this figure the tubing 134 d is demonstrated as partially or fully collapsed. The chamber(s) has a uniform diameter throughout it's length, is cylindrical in shape with multiple ridges 146 d and grooves 147 d throughout the length of the chamber. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The chamber 134 d connects the two hollow cylindrical tubes 135 d and 138 d. Tube 135 d represents the expanded view of the tubes 10 a and 13 a and tube 138 d represents the expanded view of the tubes 44 a and 47 a as shown in FIG. 1A. Tube 135 d has an inlet end 136 d and an outlet end 137 d. Tube 138 d has an inlet end 139 d and an outlet end 140 d. The points of attachments of the tubing 134 d to the tube 135 d is between the inlet 136 d and outlet 137 d and is demonstrated in the figure as 141 d. The points of attachments of the tubing 134 d to the tube 138 d is between the inlet 139 d and outlet 140 d and is demonstrated in the figure as 142 d. The multiple rings 143 d of the coil are demonstrated in the figure as dotted lines. The chamber may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together as has been demonstrated in this figure. The distance 144 d and 145 d between the two adjacent rings of the coil 143 d, the ridges 146 d or the grooves 147 d may or may not be equal when partially collapsed. When fully collapsed, the inlet end 136 d of the tube 135 d may fuse or mate with the outlet end 140 d of the outlet tube 138 d as has been demonstrated in this figure.

FIG. 4E is an expanded plan view of tubes 50 a or 51 a according to the second alternative embodiment of the present invention as described in FIGS. 4A and 4B. FIG. 4E is an expanded plan view of the collapsible/expandable tubings 50 a and 51 a as described in FIG. 1A that connect the peripheral tubes at 3 and 9 o'clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o'clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as 134 e may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. The tubing 134 e in this figure is illustrated as fully expanded The chamber(s) has a uniform diameter throughout it's length, is cylindrical in shape with multiple ridges 146 e and grooves 147 e throughout the length of the chamber. Quite unlike FIG. 4C, the chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber 134 e connects the two hollow cylindrical tubes 135 e and 138 e. Tube 135 e represents the expanded view of the tubes 10 a and 13 a and tube 138 e represents the expanded view of the tubes 44 a and 47 a as shown in FIG. 1A. Tube 135 e has an inlet end 136 e and an outlet end 137 e. Tube 138 e has an inlet end 139 e and an outlet end 140 e. The points of attachments of the tubing 134 e to the tube 135 e is between the inlet 136 e and outlet 137 e and is demonstrated in the figure as 141 e. The points of attachments of the tubing 134 e to the tube 138 e is between the inlet 139 e and outlet 140 e and is demonstrated in the figure as 142 e. The multiple rings 143 e of the coil are demonstrated in the figure as dotted lines. The distance 144 e and 145 e between the two adjacent rings of the coil 143 e, the ridges 146 e or the grooves 147 e may be equal.

FIG. 4F is an expanded plan view of tubes 50 a or 51 a according to the second alternative embodiment of the present invention as described in FIGS. 4A and 4B. FIG. 4F is an expanded plan view of the collapsible/expandable tubings 50 a and 51 a as described in FIG. 1A that connect the peripheral tubes at 3 and 9 o'clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o'clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as 134 f may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. In this figure the tubing 134 f is demonstrated as partially or fully collapsed. The chamber(s) has a uniform diameter throughout it's length, is cylindrical in shape with multiple ridges 146 f and grooves 147 f throughout the length of the chamber. Quite unlike FIG. 4C, the chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber. The chamber 134 f connects the two hollow cylindrical tubes 135 f and 138 f. Tube 135 f represents the expanded view of the tubes 10 a and 13 a and tube 138 f represents the expanded view of the tubes 44 a and 47 a as shown in FIG. 1A. Tube 135 f has an inlet end 136 f and an outlet end 137 f. Tube 138 f has an inlet end 139 f and an outlet end 140 f. The points of attachments of the tubing 134 f to the tube 135 f is between the inlet 136 f and outlet 137 f and is demonstrated in the figure as 141 f. The points of attachments of the tubing 134 f to the tube 138 f is between the inlet 139 f and outlet 140 f and is demonstrated in the figure as 142 f. The multiple rings 143 f of the coil are demonstrated in the figure as dotted lines. The chamber may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together as has been demonstrated in this figure. The distance 144 f and 145 f between the two adjacent rings of the coil 143 f, the ridges 146 f or the grooves 147 f may or may not be equal when partially collapsed. When fully collapsed, the inlet end 136 f of the tube 135 f may fuse or mate with the outlet end 140 f of the outlet tube 138 f as has been demonstrated in this figure.

FIG. 5A is an expanded cross-sectional view of the inlet end 2 a of the invention as described in FIG. 1A. FIG. 5A is an expanded cross-sectional view of the inlet end 2 a of the MDI chamber 1 a as described in FIG. 1A.

The inlet end has been illustrated in this figure as 148 a (corresponds to 2 a of FIG. 1A) with an outer circumference 149 a. It has three hollow cylindrical inlet tubes, a central tube 150 a (corresponds to 7 a of FIG. 1A) and two peripheral tubes 151 a (corresponds to 10 a of FIG. 1A) and 152 a (corresponds to 13 a of FIG. 1A) located at three o'clock to nine o'clock positions, respectively.

FIG. 5B is an expanded cross-sectional view according to the first alternative embodiment of the present invention of the inlet end 2 a as described in FIG. 5A. The inlet end has been illustrated in this figure as 148 b (corresponds to 2 a of FIG. 1A) with an outer circumference 149 b. It has three hollow cylindrical inlet tubes, a central tube 150 b (corresponds to 7 a of FIG. 1A) and two peripheral tubes 151 b (corresponds to 10 a of FIG. 1A) and 152 b (corresponds to 13 a of FIG. 1A) located at three o'clock to nine o'clock positions. The inlet of the peripheral tube 151 b splits into multiple micrometric openings 153 b at it's outlet distributed along one hemisphere of the inlet end 148 b. The inlet of the peripheral tube 152 b similarly splits into multiple micrometric openings 154 b at it's outlet distributed along the other hemisphere of the inlet end 148 b of the MDI chamber. The aerosol particles from the nebulizer chamber enter into the MDI chamber either through the central inlet tube 150 b or through the inlet ends 151 b and 152 b of the peripheral tubes. After entering the inlet ends 151 b and 152 b of the peripheral tubes, the aerosol particles enter into the MDI chamber through the multiple micrometric openings 153 b and 154 b. Hence the aerosol particles and or gas(es)move from the nebulizer chamber to the MDI chamber through central and or peripheral connections.

FIG. 6A is an expanded cross-sectional view of the inhalation/exhalation valve assemblies 32 a or 35 a of the invention as described in FIG. 1A. In FIG. 1A the outlet tube of the MDI 16 a has been demonstrated to have two valve assemblies disposed between the inlet end 17 a and the outlet end 18 a—the inhalation valve assembly and an exhalation valve assembly. The two valve assemblies are illustrated here in FIG. 6A. The inhalation/exhalation flap valve assembly has a circular flap valve seat 155 a shown as the shaded area in this figure that has a circular opening 158 a. The flap valve seat has an outer circumference 156 a and an inner circumference 157 a. A circular flap valve 159 a is attached to the flap valve seat 155 a at point 160 a as demonstrated by a dark curvilinear line. The rest of the flap valve has a free edge 161 a as demonstrated by the dotted line that rests on the flap valve seat 155 a. On inhalation, the free edge of the inhalation flap valve moves away from the valve seat for the aerosol particles to move from the MDI chamber to the patient through the opening in the valve seat. On exhalation, the free edge of the flap valve moves towards the flap valve seat and closes the opening to prevent any flow of gas exhaled by the patient from entering into the MDI chamber thus avoiding re-breathing of carbon dioxide on the next inhalation. The exhalation flap valve assembly has a flap valve, the free edge of which presses against the flap valve seat on inhalation and completely occludes the opening to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece or MDI chamber on inhalation. On exhalation the free edge of the flap valve moves away from the flap valve seat for the air exhaled by the patient to escape into the atmosphere from the opening in the MDI outlet tube/mouthpiece/facemask.

FIG. 6B is an expanded cross-sectional view of the first alternative embodiment of the present invention of the inhalation/exhalation valve assemblies 32 a or 35 a as described in FIG. 6A. In FIG. 1A the outlet tube of the MDI 16 a has been demonstrated to have two valve assemblies disposed between the inlet end 17 a and the outlet end 18 a—the inhalation valve assembly and an exhalation valve assembly. The expanded views of the two valve assemblies are illustrated here in FIG. 6B. The inhalation/exhalation flap valve assembly has a circular flap valve seat 155 b shown as the shaded area in this figure that has a circular opening 158 b. The flap valve seat has an outer circumference 156 b and an inner circumference 157 b. A circular flap valve 159 b is attached to the flap valve seat 155 b at point 160 b as demonstrated by a dark curvilinear line. The major difference between FIGS. 6A and 6B is that the attachment of the flap valve to the valve seat in FIG. 6B on the superior aspect of the valve seat as opposed to the lateral aspect as shown in FIG. 6A. The rest of the flap valve has a free edge 161 b as demonstrated by the dotted line that rests on the flap valve seat 155 b. On inhalation, the free edge of the inhalation flap valve moves away from the valve seat for the aerosol particles to move from the MDI chamber to the patient through the opening in the valve seat. On exhalation, the free edge of the flap valve moves towards the flap valve seat and closes the opening to prevent any flow of gas exhaled by the patient from entering into the MDI chamber thus avoiding re-breathing of carbon dioxide on the next inhalation. The exhalation flap valve assembly has a flap valve, the free edge of which presses against the flap valve seat on inhalation and completely occludes the opening to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece or MDI chamber on inhalation. On exhalation the free edge of the flap valve moves away from the flap valve seat for the air exhaled by the patient to escape into the atmosphere from the opening in the MDI outlet tube/mouthpiece/facemask.

FIG. 6C is an expanded cross-sectional view of the second alternative embodiment of the present invention of the inhalation/exhalation valve assemblies 32 a or 35 a as described in FIG. 6A. FIG. 6C is an expanded cross-sectional view of an alternative embodiment of the inhalation or exhalation flap valve assemblies as shown in FIGS. 6A and 6B. The expanded views of the two valve assemblies are illustrated here in FIG. 6C. The inhalation/exhalation flap valve assembly has a circular flap valve seat 155 c shown as the shaded area in this figure that has a circular opening 158 c. The flap valve seat has an outer circumference 156 c and an inner circumference 157 c. The circular flap valve 159 c is now split into two hemispheres 160 c and 161 c. The flap valve 160 c is attached to the flap valve seat 155 c at point 162 c as demonstrated by a dark curvilinear line. The rest of the flap valve has a free edge 163 c as demonstrated by the dotted line that rests on the flap valve seat 155 c. The flap valve 161 c is attached to the flap valve seat 155 c at point 164 c as demonstrated by a dark curvilinear line. The rest of the flap valve has a free edge 165 c as demonstrated by the dotted line that rests on the flap valve seat 155 c. The two free edges meet at the center line 166 c such that there is no gap between the two free edges. On inhalation, the two free edges of the inhalation flap valve move away from the valve seat for the aerosol particles to move from the MDI chamber to the patient through the opening in the valve seat. On exhalation, the free edges of the flap valve move towards the flap valve seat and close the opening to prevent any flow of gas exhaled by the patient from entering into the MDI chamber thus avoiding re-breathing of carbon dioxide on the next inhalation. In the exhalation flap valve assembly, the two free edges of the flap valve presses against the flap valve seat on inhalation and completely occlude the opening to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece or MDI chamber on inhalation. On exhalation the free edges of the flap valve move away from the flap valve seat for the air exhaled by the patient to escape into the atmosphere from the opening in the MDI outlet tube/mouthpiece/facemask.

FIG. 7A is a plan view of the longitudinal length of the mouthpiece according to one embodiment of the present invention. The mouthpiece is a hollow cylindrical tube that is connected to the MDI chamber at one end and to the patient at the other end for inhalation of the aerosol medication generated either by the nebulizer or by the MDI in the device demonstrated in FIG. 1A. In FIG. 1A the outlet tube of the MDI 16 a has been demonstrated to have two valve assemblies disposed between the inlet end 17 a and the outlet end 18 a—the inhalation valve assembly and an exhalation valve assembly. The mouthpiece that is illustrated in this figure as 166 a is attached to the outlet end 18 a of the tube 16 a shown in FIG. 1A. The mouthpiece 166 a has an inlet end 167 a and an outlet end 168 a. Instead of the flap valve assemblies being located in the outlet tube 16 a of FIG. 1A, the inhalation valve assembly and an exhalation valve assembly could alternatively be disposed between the inlet end 167 a and the outlet end 168 a of the mouthpiece 166 a. The inhalation flap valve assembly has a circular flap valve seat 169 a that has a circular opening 170 a and a flap valve 171 a as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 172 a that has a circular opening 173 a and a flap valve 174 a as demonstrated by the dotted line. On inhalation, the inhalation flap valve 171 a moves away from the valve seat 169 a for the aerosol particles to move from the MDI chamber to the patient through the opening 170 a in the valve seat 169 a of the mouthpiece 166 a. On exhalation, the flap valve 171 a moves towards the flap valve seat 169 a and closes the opening 170 a to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 1 a thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 169 a prevents any protrusion of the flap valve 171 a through the opening 170. The exhalation flap valve assembly has a flap valve 174 a that presses against the flap valve seat 172 a on inhalation and completely occludes the opening 173 a to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece 166 a on inhalation. On exhalation the flap valve 174 a moves away from the flap valve seat 172 a for the air exhaled by the patient to escape into the atmosphere from tube 166 a through the opening 173 a.

FIG. 7B is a plan view of the longitudinal length of the facemask according to one embodiment of the present invention. The facemask is connected to the MDI chamber at one end and to the patient at the other end for inhalation of the aerosol medication generated either by the nebulizer or by the MDI as demonstrated in the device in FIG. 1A. In FIG. 1A the outlet tube of the MDI 16 a has been demonstrated to have two valve assemblies disposed between the inlet end 17 a and the outlet end 18 a—the inhalation valve assembly and an exhalation valve assembly. The facemask that is illustrated in this FIG. 7B as 166 b is attached to the outlet end 18 a of the tube 16 a shown in FIG. 1A. The facemask 166 b has an inlet end 167 b and an outlet end 168 b. Instead of the flap valve assemblies being located in the outlet tube 16 a of FIG. 1A, the inhalation valve assembly and an exhalation valve assembly could alternatively be disposed between the inlet end 167 b and the outlet end 168 b of the facemask 166 b. The inhalation flap valve assembly has a circular flap valve seat 169 b that has a circular opening 170 b and a flap valve 171 b as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 172 b that has a circular opening 173 b and a flap valve 174 b as demonstrated by the dotted line. On inhalation, the inhalation flap valve 171 b moves away from the valve seat 169 b for the aerosol particles to move from the MDI chamber to the patient through the opening 170 b in the valve seat 169 b of the mouthpiece 166 b. On exhalation, the flap valve 171 b moves towards the flap valve seat 169 b and closes the opening 170 b to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 1 a thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 169 b prevents any protrusion of the flap valve 171 b through the opening 170 b. The exhalation flap valve assembly has a flap valve 174 b that presses against the flap valve seat 172 b on inhalation and completely occludes the opening 173 b to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece 166 b on inhalation. On exhalation the flap valve 174 b moves away from the flap valve seat 172 b for the air exhaled by the patient to escape into the atmosphere from tube 166 b through the opening 173 b. FIG. 7B demonstrates an additional inhalation flap valve assembly disposed between the inlet end and the outlet end of the facemask located diametrically opposite to the one described before (166 b, 167 b, 168 b). The additional inhalation valve assembly is optional. It has a circular flap valve seat 175 b that has a circular opening 176 b and a flap valve 177 b as demonstrated by the dotted line. On inhalation, the inhalation flap valve 177 b moves away from the valve seat 175 b for the aerosol particles to move from the MDI chamber to the patient through the opening 176 b in the valve seat 175 b of the mouthpiece 166 b. On exhalation, the flap valve 177 b moves towards the flap valve seat 175 b and closes the opening 176 b to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 1 b thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 175 b prevents any protrusion of the flap valve 177 b through the opening 176 b.

FIG. 8A is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to an alternative embodiment of the present invention as described in FIG. 1E. FIG. 8A is an expanded plan view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in FIG. 1E with a modification. A universal actuator is disposed between the inlet end and the outlet end of the tube located at the inlet end of the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI. The inlet end of the tube located at the inlet end of the nebulizer chamber can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The MDI chamber 178 a has an outlet end 180 a. The nebulizer chamber 181 a has an inlet end 182 a. The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as 1792 a 183 a. The outlet end 180 a of the MDI chamber 178 a has a hollow cylindrical tube 193 a with an inlet end 194 a and an outlet end 195 a. The MDI chamber 178 a may be made of plastic, paper, or metal. The chamber 178 a may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 196 a and grooves 197 a. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 198 a of the coil are demonstrated in the figure as dotted lines. The distance 199 a and 200 a between the two adjacent ridges, rings of the coil, or grooves may be equal. The outlet tube 193 a of the MDI chamber 178 a has two valve assemblies disposed between the inlet end 194 a and the outlet end 195 a—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 209 a that has a circular opening 210 a and a flap valve 211 a as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 212 a that has a circular opening 213 a and a flap valve 214 a as demonstrated by the dotted line. On inhalation, the inhalation flap valve 211 a moves away from the valve seat 209 a for the aerosol particles to move from the MDI chamber 178 a to the patient through the opening 210 a in the valve seat 209 a of the tube 193 a. On exhalation, the flap valve 211 a moves towards the flap valve seat 209 a and closes the opening 210 a to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 178 a thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 209 a prevents any protrusion of the flap valve 211 a through the opening 210 a. The exhalation flap valve assembly has a flap valve 214 a that presses against the flap valve seat 212 a on inhalation and completely occludes the opening 213 a to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 193 a on inhalation. On exhalation the flap valve 214 a moves away from the flap valve seat 212 a for the air exhaled by the patient to escape into the atmosphere from tube 193 a through the opening 213 a. The nebulizer chamber 181 a has a hollow cylindrical inlet tube 215 a with an inlet end 216 a and an outlet end 217 a. The inlet and 216 a can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, a universal actuator 207 a may be disposed between the inlet end 216 e and the outlet end 217 a of the tube 215 a. The nozzle 206 a of a canister 205 a of any commercially available MDI may be attached to an actuator 207 a. The actuator 207 a has an opening or an aperture 208 a. On actuation of the MDI canister 205 a, the medication aerosol particles are generated through the opening 208 a of the actuator 207 a.

The nebulizer chamber has an inlet port 229 a for connection with a standard small volume nebulizer 230 a. The aerosol medication generated with the nebulizer 230 a can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 179 a 183 a. Chamber 181 a also has another inlet 231 a for connection a reservoir bag 232 a. The reservoir bag 232 a serves to store the aerosol particles generated by the nebulizer 230 a during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 232 a has two small inlets 233 a and 234 a to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 8B is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention as described in FIG. 8A. FIG. 8B is an expanded plan view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in FIG. 8A with modifications. At the inlet end of the nebulizer chamber, there are two hollow concentric tubes, an inner and an outer. A universal actuator is disposed between the inlet end and the outlet end of the inner concentric tube. The inlet end of the inner concentric hollow tube is closed and the outlet end is open and in communication with the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI into the nebulizer chamber through outlet end of the tube that is in communication with the nebulizer chamber. The outlet concentric tube is fused with the inlet end of the nebulizer chamber at one end and is open at the opposite end. Hence the gas(es) from the atmosphere or another outside gas source can flow into the nebulizer chamber from the inlet open inlet end of the outer concentric tube through the connection between the outlet end of the outer concentric tube and the inlet end of the nebulizer chamber. The flow is only peripheral and there is no central flow as the inlet end of the inner concentric tube is closed. The open end of the outer concentric tube can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The MDI chamber 178 b has an outlet end 180 b. The nebulizer chamber 181 b has an inlet end 182 b which may be a single opening or it may have multiple micrometric openings. The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as 179 b 183 b. The outlet end 180 b of the MDI chamber 178 b has a hollow cylindrical tube 193 b with an inlet end 194 b and an outlet end 195 b. The MDI chamber 178 b may be made of plastic, paper, or metal. The chamber 178 b may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 196 b and grooves 197 b. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 198 b of the coil are demonstrated in the figure as dotted lines. The distance 199 b and 200 b between the two adjacent ridges, rings of the coil, or grooves may be equal. The outlet tube 193 b of the MDI chamber 178 b has two valve assemblies disposed between the inlet end 194 b and the outlet end 195 b—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 209 b that has a circular opening 210 b and a flap valve 211 b as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 212 b that has a circular opening 213 b and a flap valve 214 b as demonstrated by the dotted line. On inhalation, the inhalation flap valve 211 b moves away from the valve seat 209 b for the aerosol particles to move from the MDI chamber 178 b to the patient through the opening 210 b in the valve seat 209 b of the tube 193 b. On exhalation, the flap valve 211 b moves towards the flap valve seat 209 b and closes the opening 210 b to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 178 b thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 209 b prevents any protrusion of the flap valve 211 b through the opening 210 b. The exhalation flap valve assembly has a flap valve 214 b that presses against the flap valve seat 212 b on inhalation and completely occludes the opening 213 b to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 193 b on inhalation. On exhalation the flap valve 214 b moves away from the flap valve seat 212 b for the air exhaled by the patient to escape into the atmosphere from tube 193 b through the opening 213 b.

The nebulizer chamber 181 b is connected to two hollow cylindrical concentric tubes—a hollow cylindrical inner inlet tube 215 b with an inlet end 216 b and an outlet end 217 b. The inlet end 216 b of the inner concentric hollow tube is closed and the outlet end 217 b is open and in communication with the nebulizer chamber 181 b. A universal actuator 207 b may be disposed between the inlet end 216 b and the outlet end 217 b of the tube 215 b. The nozzle 206 b of a canister 205 b of any commercially available MDI may be attached to an actuator 207 b. The actuator 207 b has an opening or an aperture 208 b. On actuation of the MDI canister 205 a, the medication aerosol particles are generated through the opening 208 b of the actuator 207 b and the medication delivered into the nebulizer chamber 181 b through outlet end 217 b of the tube 215 b. The outlet concentric tube 235 b is fused with the inlet end 182 b of the nebulizer chamber 181 b at one end and has an opening 236 a at the opposite end. Hence the gas(es) from the atmosphere or another outside gas source can flow into the nebulizer chamber 181 b from the inlet opening 236 b of the outer concentric tube 235 b through the connection between the outer concentric tube and the inlet end 182 b of the nebulizer chamber 181 b. The flow is only peripheral and there is no central flow as the inlet end 216 b of the inner concentric tube 215 b is closed. The open end 236 b of the outer concentric tube 235 a can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The nebulizer chamber has an inlet port 229 b for connection with a standard small volume nebulizer 230 b. The aerosol medication generated with the nebulizer 230 b can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 179 e 183 e. Chamber 181 b also has another inlet 231 b for connection a reservoir bag 232 b. The reservoir bag 232 b serves to store the aerosol particles generated by the nebulizer 230 b during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 232 b has two small inlets 233 b and 234 b to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 8C is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention as described in FIG. 8A. FIG. 8C is an expanded view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in FIG. 8B with a single modification. At the inlet end of the nebulizer chamber, there are two hollow concentric tubes, an inner and an outer. A universal actuator is disposed between the inlet end and the outlet end of the inner concentric tube. The inlet end of the inner concentric hollow tube is open in this figure as opposed to the closed end observed in FIG. 8B and the outlet end is open and in communication with the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI into the nebulizer chamber through outlet end of the tube that is in communication with the nebulizer chamber. The outlet concentric tube is fused with the inlet end of the nebulizer chamber at one end and is open at the opposite end. Hence the gas(es) from the atmosphere or another outside gas source can flow into the nebulizer chamber from the inlet open inlet end of the outer concentric tube through the connection between the outlet end of the outer concentric tube and the inlet end of the nebulizer chamber. The flow is only peripheral and there is no central flow as the inlet end of the inner concentric tube is closed. The open end of the outer concentric tube can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The MDI chamber 178 c has an outlet end 180 c. The nebulizer chamber 181 c has an inlet end 182 c which may be a single opening or it may have multiple micrometric openings. The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as 179 c 183 c. The outlet end 180 c of the MDI chamber 178 c has a hollow cylindrical tube 193 c with an inlet end 194 c and an outlet end 195 c. The MDI chamber 178 c may be made of plastic, paper, or metal. The chamber 178 c may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 196 c and grooves 197 c. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 198 c of the coil are demonstrated in the figure as dotted lines. The distance 199 c and 200 c between the two adjacent ridges, rings of the coil, or grooves may be equal. The outlet tube 193 c of the MDI chamber 178 c has two valve assemblies disposed between the inlet end 194 c and the outlet end 195 c—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 209 c that has a circular opening 210 c and a flap valve 211 c as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 212 c that has a circular opening 213 c and a flap valve 214 c as demonstrated by the dotted line. On inhalation, the inhalation flap valve 211 c moves away from the valve seat 209 c for the aerosol particles to move from the MDI chamber 178 c to the patient through the opening 210 c in the valve seat 209 c of the tube 193 c. On exhalation, the flap valve 211 c moves towards the flap valve seat 209 c and closes the opening 210 c to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 178 c thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 209 c prevents any protrusion of the flap valve 211 c through the opening 210 c. The exhalation flap valve assembly has a flap valve 214 c that presses against the flap valve seat 212 c on inhalation and completely occludes the opening 213 c to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 193 c on inhalation. On exhalation the flap valve 214 c moves away from the flap valve seat 212 c for the air exhaled by the patient to escape into the atmosphere from tube 193 c through the opening 213 c.

The nebulizer chamber 181 c is connected to two hollow cylindrical concentric tubes—a hollow cylindrical inner inlet tube 215 c with an inlet end 216 c and an outlet end 217 c. The inlet end 216 c of the inner concentric hollow tube is open and the outlet end 217 c is in communication with the nebulizer chamber 181 c. A universal actuator 207 c may be disposed between the inlet end 216 c and the outlet end 217 c of the tube 215 c. The nozzle 206 c of a canister 205 c of any commercially available MDI may be attached to an actuator 207 c. The actuator 207 c has an opening or an aperture 208 c. On actuation of the MDI canister 205 c, the medication aerosol particles are generated through the opening 208 c of the actuator 207 c and the medication delivered into the nebulizer chamber 181 c through outlet end 217 c of the tube 215 c. The outlet concentric tube 235 c is fused with the inlet end 182 c of the nebulizer chamber 181 c at one end and has an opening 236 c at the opposite end. Hence the gas(es) from the atmosphere or another outside gas source can flow into the nebulizer chamber 181 c from the inlet openings 236 c of the outer concentric tube 235 c and the inlet opening 216 c of the inner concentric tube 235 c through the connections between the outer concentric tube 235 c and the nebulizer chamber 181 c and the inner concentric tube 215 c and the inlet end 182 c of the nebulizer chamber 181 c. The flow is now both central and peripheral from the outside source to the nebulizer chamber. The open end 236 c of the outer concentric tube 235 c and the open end 216 c of the inner tube 215 c can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The nebulizer chamber has an inlet port 229 c for connection with a standard small volume nebulizer 230 c. The aerosol medication generated with the nebulizer 230 c can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 179 c 183 c. Chamber 181 c also has another inlet 231 c for connection a reservoir bag 232 c. The reservoir bag 232 c serves to store the aerosol particles generated by the nebulizer 230 c during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 232 c has two small inlets 233 c and 234 c to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

FIG. 8D is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the alternative embodiment of the present invention as described in FIG. 2E. FIG. 8D is an expanded view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in FIG. 2E with modifications. A universal actuator is disposed between the inlet end and the outlet end of the tube located at the inlet end of the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI. The inlet end of the tube located at the inlet end of the nebulizer chamber can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The MDI chamber 178 d has an outlet end 180 d. The nebulizer chamber 181 d has an inlet end 182 d. The inlet end of the MDI chamber land the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as 179 d 183 d. The outlet end 180 d of the MDI chamber 178 d has a hollow cylindrical tube 193 d with an inlet end 194 d and an outlet end 195 d. The MDI chamber 178 d may be made of plastic, paper, or metal. The chamber 178 d may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 196 d and grooves 197 d. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 198 a of the coil are demonstrated in the figure as dotted lines. The distance 199 d and 200 d between the two adjacent ridges, rings of the coil, or grooves may be equal.

The outlet tube 193 d of the MDI chamber 178 d has two valve assemblies disposed between the inlet end 194 d and the outlet end 195 d—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 209 d that has a circular opening 210 d and a flap valve 211 d as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 212 d that has a circular opening 213 d and a flap valve 214 d as demonstrated by the dotted line. On inhalation, the inhalation flap valve 211 d moves away from the valve seat 209 d for the aerosol particles to move from the MDI chamber 178 d to the patient through the opening 210 d in the valve seat 209 d of the tube 193 d. On exhalation, the flap valve 211 d moves towards the flap valve seat 209 d and closes the opening 210 d to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 178 d thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 209 d prevents any protrusion of the flap valve 211 d through the opening 210 d. The exhalation flap valve assembly has a flap valve 214 d that presses against the flap valve seat 212 d on inhalation and completely occludes the opening 213 d to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 193 d on inhalation. On exhalation the flap valve 214 d moves away from the flap valve seat 212 d for the air exhaled by the patient to escape into the atmosphere from tube 193 d through the opening 213 d.

The nebulizer chamber 181 d has an hollow cylindrical inlet tube 215 d at it's inlet end 182 d. The inlet tube 215 d has an inlet end 216 d and an outlet end 217 d. The inlet end 182 d of the nebulizer chamber 181 d may be closed at it's periphery 246 d shown as the shaded area in the figure and open in the center 247 d where it fuses with the tube 215 d and the two openings 217 d and 247 d fuse with each other. A universal actuator 207 d may be disposed between the inlet end 216 d and the outlet end 217 d of the tube 215 d. The nozzle 206 d of a canister 205 d of any commercially available MDI may be attached to an actuator 207 d. The actuator 207 d has an opening or an aperture 208 d. On actuation of the MDI canister 205 d, the medication aerosol particles are generated through the opening 208 d of the actuator 207 d. The flow of the gas(es) from the nebulizer chamber 181 d to the MDI chamber is central through the opening 216 d of the tube 215 d as the peripheral part of the MDI chambers inlet 182 d is closed.

The nebulizer chamber has an inlet port 229 d for connection with a standard small volume nebulizer 230 d. The aerosol medication generated with the nebulizer 230 d can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 179 e 183 e. Chamber 181 d also has another inlet 231 d for connection a reservoir bag 232 d. The reservoir bag 232 d serves to store the aerosol particles generated by the nebulizer 230 d during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 232 d has two small inlets 233 d and 234 d to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag 232 d may be replaced by a corrugated plastic reservoir tubing 237 d that may be connected to inlet end 216 d of the nebulizer chamber 181 d. The reservoir tubing 237 d may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 238 d and grooves 239 d. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 240 d of the coil are demonstrated in the figure as dotted lines. The distance 241 d and 242 d between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag 232 d or reservoir tubing 237 d serves to store the aerosol particles generated by the nebulizer 230 d during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end 238 d that may have a hollow cylindrical inlet tube 243 d with an inlet end 244 d and an outlet end 245 d. The inlet end 244 d can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI 205 d can be connected to the inlet end 244 d of the inlet tube 243 d and on actuation the aerosol particles generated by the MDI will be transferred from the reservoir tubing 232 d to the nebulizer chamber 181 d and then to the MDI chamber 178 d.

FIG. 8E is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention as described in FIG. 8D. FIG. 8E is an expanded view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in FIG. 2E with modifications. A universal actuator is disposed between the inlet end and the outlet end of the tube located at the inlet end of the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI. The inlet end of the tube located at the inlet end of the nebulizer chamber can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The MDI chamber 178 e has an outlet end 180 e. The nebulizer chamber 181 e has an inlet end 182 e. The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as 179183 e. The outlet end 180 e of the MDI chamber 178 e has a hollow cylindrical tube 193 e with an inlet end 194 e and an outlet end 195 e. The MDI chamber 178 e may be made of plastic, paper, or metal. The chamber 178 e may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 196 e and grooves 197 e. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 198 e of the coil are demonstrated in the figure as dotted lines. The distance 199 e and 200 e between the two adjacent ridges, rings of the coil, or grooves may be equal.

The outlet tube 193 e of the MDI chamber 178 e has two valve assemblies disposed between the inlet end 194 e and the outlet end 195 e—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 209 e that has a circular opening 210 e and a flap valve 211 e as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 212 e that has a circular opening 213 e and a flap valve 214 e as demonstrated by the dotted line. On inhalation, the inhalation flap valve 211 e moves away from the valve seat 209 e for the aerosol particles to move from the MDI chamber 178 e to the patient through the opening 210 e in the valve seat 209 e of the tube 193 e. On exhalation, the flap valve 211 e moves towards the flap valve seat 209 e and closes the opening 210 e to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 178 e thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 209 e prevents any protrusion of the flap valve 211 e through the opening 210 e. The exhalation flap valve assembly has a flap valve 214 e that presses against the flap valve seat 212 e on inhalation and completely occludes the opening 213 e to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 193 e on inhalation. On exhalation the flap valve 214 e moves away from the flap valve seat 212 e for the air exhaled by the patient to escape into the atmosphere from tube 193 e through the opening 213 e.

The nebulizer chamber 181 e has an hollow cylindrical inlet tube 215 e at it's inlet end 182 e. The inlet tube 215 e has an inlet end 216 e and an outlet end 217 e. The inlet end 182 e of the neulizer chamber 181 e is open quite unlike the closed periphery 246 e shown as the shaded area in FIG. 8D. The inlet end 216 e of the inlet tube 215 e is closed. A universal actuator 207 e may be disposed between the inlet end 216 e and the outlet end 217 e of the tube 215 e. The nozzle 206 e of a canister 205 e of any commercially available MDI may be attached to an actuator 207 e. The actuator 207 e has an opening or an aperture 208 e. On actuation of the MDI canister 205 e, the medication aerosol particles are generated through the opening 208 e of the actuator 207 e. The flow of the gas(es) from the nebulizer chamber 181 e to the MDI chamber is peripheral through the opening 246 e of the nebulizer chamber 181 e. There is no central flow of gas(es)from the nebulizer chamber to the MDI chamber as the inlet end 216 e of the inlet tube tube 215 e is closed.

The nebulizer chamber has an inlet port 229 e for connection with a standard small volume nebulizer 230 e. The aerosol medication generated with the nebulizer 230 e can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 179 e 183 e. Chamber 181 e also has another inlet 231 e for connection a reservoir bag 232 e. The reservoir bag 232 e serves to store the aerosol particles generated by the nebulizer 230 e during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 232 e has two small inlets 233 e and 234 e to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

Alternatively, the reservoir bag 232 e may be replaced by a corrugated plastic reservoir tubing 237 e that may be connected to inlet end 216 e of the nebulizer chamber 181 e. The reservoir tubing 237 e may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 238 e and grooves 239 e. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 240 e of the coil are demonstrated in the figure as dotted lines. The distance 241 e and 242 e between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag 232 e or reservoir tubing 237 e serves to store the aerosol particles generated by the nebulizer 230 e during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end 238 e that may have a hollow cylindrical inlet tube 243 e with an inlet end 244 e and an outlet end 245 e. The inlet end 244 e can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI 205 e can be connected to the inlet end 244 e of the inlet tube 243 e and on actuation the aerosol particles generated by the MDI will be transferred from the reservoir tubing 232 e to the nebulizer chamber 181 e and then to the MDI chamber 178 e.

FIG. 8F is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention as described in FIG. 8D. FIG. 8F is an expanded view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in FIG. 2E with modifications. A universal actuator is disposed between the inlet end and the outlet end of the tube located at the inlet end of the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI. The inlet end of the tube located at the inlet end of the nebulizer chamber can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

The MDI chamber 178 f has an outlet end 180 f. The nebulizer chamber 181 f has an inlet end 182 f. The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as 179 f 183 f. The outlet end 180 f of the MDI chamber 178 f has a hollow cylindrical tube 193 f with an inlet end 194 f and an outlet end 195 f. The MDI chamber 178 f may be made of plastic, paper, or metal. The chamber 178 f may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 196 f and grooves 197 f. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 198 f of the coil are demonstrated in the figure as dotted lines. The distance 199 f and 200 f between the two adjacent ridges, rings of the coil, or grooves may be equal.

The outlet tube 193 f of the MDI chamber 178 f has two valve assemblies disposed between the inlet end 194 f and the outlet end 195 f—the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat 209 f that has a circular opening 210 f and a flap valve 211 f as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat 212 f that has a circular opening 213 f and a flap valve 214 f as demonstrated by the dotted line. On inhalation, the inhalation flap valve 211 f moves away from the valve seat 209 f for the aerosol particles to move from the MDI chamber 178 f to the patient through the opening 210 f in the valve seat 209 f of the tube 193 f. On exhalation, the flap valve 211 f moves towards the flap valve seat 209 f and closes the opening 210 f to prevent any flow of gas exhaled by the patient from entering into the MDI chamber 178 f thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat 209 f prevents any protrusion of the flap valve 211 f through the opening 210 f. The exhalation flap valve assembly has a flap valve 214 f that presses against the flap valve seat 212 f on inhalation and completely occludes the opening 213 f to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube 193 f on inhalation. On exhalation the flap valve 214 f moves away from the flap valve seat 212 f for the air exhaled by the patient to escape into the atmosphere from tube 193 f through the opening 213 f.

The nebulizer chamber 181 f has an hollow cylindrical inlet tube 215 f at it's inlet end 182 f. The inlet tube 215 f has an inlet end 216 f and an outlet end 217 f. The inlet end 182 f of the neulizer chamber 181 f is open quite like the opening in FIG. 8E. The inlet end 216 f of the inlet tube 215 f is also open unlike the closed inlet end in FIG. 8E. A universal actuator 207 f may be disposed between the inlet end 216 f and the outlet end 217 f of the tube 215 f. The nozzle 206 f of a canister 205 f of any commercially available MDI may be attached to an actuator 207 f. The actuator 207 f has an opening or an aperture 208 f. On actuation of the MDI canister 205 f, the medication aerosol particles are generated through the opening 208 f of the actuator 207 f. The flow of the gas(es) from the nebulizer chamber 181 f to the MDI chamber is peripheral through the opening 246 f of the nebulizer chamber 181 f. There is central and peripheral flow of gas(es)from the nebulizer chamber to the MDI chamber through the inlet end 216 f of the inlet tube tube 215 f and the inlet opening 182 f of the nebulizer chamber 181 f, respectively.

The nebulizer chamber has an inlet port 229 f for connection with a standard small volume nebulizer 230 f. The aerosol medication generated with the nebulizer 230 f can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber 179 f 183 f. Chamber 181 f also has another inlet 231 f for connection a reservoir bag 232 f. The reservoir bag 232 f serves to store the aerosol particles generated by the nebulizer 230 f during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag 232 f has two small inlets 233 f and 234 f to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.

Alternatively, the reservoir bag 232 f may be replaced by a corrugated plastic reservoir tubing 237 f that may be connected to inlet end 216 f of the nebulizer chamber 181 f. The reservoir tubing 237 f may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges 238 f and grooves 239 f. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings 240 f of the coil are demonstrated in the figure as dotted lines. The distance 241 f and 242 f between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag 232 f or reservoir tubing 237 f serves to store the aerosol particles generated by the nebulizer 230 f during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end 238 f that may have a hollow cylindrical inlet tube 243 f with an inlet end 244 f and an outlet end 245 f. The inlet end 244 f can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI 205 f can be connected to the inlet end 244 f of the inlet tube 243 f and on actuation the aerosol particles generated by the MDI will be transferred from the reservoir tubing 232 f to the nebulizer chamber 181 f and then to the MDI chamber 178 f.

It is noted that the illustration (drawings) and description of the preferred embodiments have been provided merely for the purpose of explanation and although the invention has been described herein with reference to particular means, materials and embodiments, the invention is not intended to be limited to the particulars disclosed herein; rather the invention intents to all functionally equivalent structures, methods and uses such as are within the scope of the appended claims. 

1) An aerosol inhalation apparatus, comprising: collapsible/expandable first housing or a fixed first housing or a partially fixed and a partially collapsible/expandable first housing with a configuration of a cylinder, a bell, a pear, a cone, or any three dimensional polygon; a first housing that is fully collapsible into a substantially compact minimum volume, fully expandable to a maximum volume and partially expandable to different volumes; a collapsible/expandable second housing or a fixed second housing or a partially fixed and partially collapsible/expandable second housing; the first housing that is connected to the second housing through one of more peripheral and/or central hollow connecting tubes; the first housing with an inhalation/exhalation outlet tube at an inhalation/exhalation end of the first housing; the inhalation/exhalation outlet tube with an inhalation/exhalation outlet port at the end of the inhalation/exhalation outlet tube; a mouthpiece or a facemask connected to the inhalation/exhalation port of the inhalation/exhalation outlet tube; the first housing with an inlet tube at a diametrically opposite end of the inhalation/exhalation outlet tube; the inlet tube with an inlet port at an end of the inlet tube; a boot adapter panel that may be connected to the inlet port of the inlet tube of the first housing; the boot adapter panel with an opening for receiving a boot of an MDI inhaler; a one way inhalation flap valve assembly that comprises of an inhalation flap valve and a valve seat for the inhalation flap valve that is disposed in the outlet port of the outlet tubing of the first housing; the one way inhalation valve assembly whereby inhalation by a patient through the inhalation/exhalation outlet port will cause the inhalation flap valve to move away from the inhalation flap valve seat to allow one way flow of gas(es) from the first housing to a mouth piece or a face mask and exhalation by a patient through the inhalation/exhalation outlet port of the first housing presses the inhalation flap against the inhalation flap valve seat to prevent the flow of exhaled gas into the first housing; a one way exhalation flap valve assembly with an exhalation flap valve with and exhalation flap valve seat for the exhalation flap valve that is disposed in a wall of the outlet port of the first housing; the one way exhalation flap valve assembly whereby exhalation by a patient through the inhalation/exhalation outlet port will cause the exhalation flap valve to move away from the exhalation flap valve seat to allow one way flow of gas exhaled from the outlet tube to outside atmosphere; the one way exhalation flap valve assembly whereby exhalation by a patient through the inhalation/exhalation outlet port will cause exhalation flap valve to move away from the exhalation flap valve seat to allow one way flow of gas from the mouthpiece or the face mask to outside atmosphere and inhalation by a patient through the inhalation/exhalation outlet port will press the exhalation flap valve against the exhalation flap valve seat to prevent the flow of gas from atmosphere to the mouthpiece or facemask or the first housing and hence a patient; said one way exhalation flap valve assembly further comprising an exhalation filter in said valve assembly to trap all exhaled aerosol medication but allowing all exhaled gas(es) to escape to atmosphere. 2) The aerosol inhalation apparatus of claim one, comprising: a collapsible/expandable first and/or second housing composed of a single piece of material that may be plastic, paper, or metal or a housing that may be composed of a combination of different such materials; said housing that may be composed of a stiff corrugated plastic material with multiple ridges and grooves or pleats like an accordion that may be collapsible/expandable said housing that does not require any support with a metal or plastic wire for patency; said housing that is expandable to a maximum volume by fully stretching all the pleats of the housing and fully collapsible by pulling all the pleats of the housing together and partially expandable/collapsible to any volume between maximum and minimum volumes by pulling the pleats together or stretching them apart; said housing with an inlet and an outlet end; said housing that may be supported by a metal or plastic wire with 2 free ends; the wire, one free end of which terminates at or near the inlet end of the housing and other free end of which terminates at the outlet end of housing; said wire that has a configuration of a coil and is arranged in spirals or multiple concentric rings; said coil is expandable when the rings are pulled apart; said coil is collapsible when the rings are pulled together; said housing is expandable when the coil rings are pulled apart and collapsible when the rings are pulled together; said housing is fully expandable to bound a fully expanded maximum volume when each ring is pulled apart from an adjoining ring and fully collapsible to minimum volume when each ring is pulled together to an adjoining ring; said housing is expandable to bound a first volume when a first coil ring is fully pulled apart from a second coil ring, and all remaining coil rings are pulled together; said first volume is expandable to bound a second volume of said housing when a third coil ring is fully pulled apart from the second spiral ring, and all or remaining coil rings pulled together; said second volume of housing is expandable to bound a third volume of housing when a fourth spiral ring is fully pulled apart from the third spiral ring, and all remaining coils pulled together; a partially expandable/collapsible volume of said housing between a maximum and a minimum volume that is further expandable to any volume less than the maximum volume by pulling apart a ring from an adjoining ring and collapsible tube any volume greater than the minimum volume by pulling together a ring to an adjoining ring; said first volume of the housing may be equal to the difference between the second and the first volume, which may be equal to the difference between the third and the second volume, such that each intervening volume obtained by expanding any two adjoining rings may be equal; said first volume housing that may be different from the difference between the second and the first volume, such that each intervening volume obtained by expanding any two adjacent rings may be unequal; minimum fully collapsible volume wherein the inlet tube of said housing may be fused with the outlet tube of said housing; any partially expandable volume of the first housing other than minimum collapsible volume wherein inlet tube of said housing is detached from the outlet tube of said housing; 3) The aerosol inhalation apparatus of claim one, comprising: a fixed volume second housing or collapsible/expandable second housing or a partially fixed and a partially expandable/collapsible second housing; a housing composed of a corrugated plastic material with multiple ridges/grooves or pleats like an accordion; a collapsible/expandable housing composed of a single piece of material; said housing with an inlet end and an outlet end; said housing with an inhalation/exhalation outlet tube at the outlet end; said housing with one or more inlet tubes at the inlet end; said inlet tube which may be connected to one or more sources of gas(es) to receive one or more gas(es) into said housing; said inlet tube that may be connected to expandable/collapsible corrugated tubing; said corrugated tubing that may connected to one or more gas sources; said housing with two ports disposed in the wall of the housing between the inlet and outlet end—a port for a nebulizer, and a port for a reservoir; said outlet end, which is plugged with a cap when using an MDI and said outlet tube of the second housing is fused with the inlet tube of the first housing when using a nebulizer; said reservoir which may be an expandable/collapsible corrugated tubing as described in claim 2 and/or a collapsible/expandable bag made of plastic or neoprene; said second housing is connected to the first housing with two peripheral collapsible/expandable connecting tubes; the two peripheral connecting tubes that are fully or partially expandable during MDI use to allow a central disconnection between the inlet tubing of the first housing and the outlet tubing of the second housing and to create a room to accommodate the MDI boot between the first and the second housing; the two peripheral connecting tubes that are fully collapsible to a minimum volume during nebulizer use to allow a central connection between the inlet tube of the first and the outlet tube of the second housing; said second housing wherein a nebulizer is connected to the nebulizer port of the housing to generate aerosol medication that is transferred to the first housing via two peripheral connecting tubes and a central connection between two housings via the outlet tube of the second housing and the inlet tube of the first housing; said second housing wherein during MDI use, the outlet tube remains plugged with a cap and the MDI is attached to the inlet tube of the first housing via a universal boot adapter assembly and a gas(es) is transferred from the second housing to the first housing via the two peripheral connecting tubes; a reservoir which stores aerosol medication generated by the nebulizer during an exhalation phase of the nebuliser to be used in a subsequent inhalation phase of a respiratory cycle; a reservoir that may have one or more inlet ports for one or more gas(es) to enter the reservoir for uniform mixing with the aerosol particles before entering the second housing and prior to inhalation by a patient. 4) An aerosol inhalation apparatus of claim one, comprising: two or more peripheral connecting tubes between the first housing and the second housing to allow a passage of aerosol medications and/or one or more gases from the first housing to the second housing; said connecting tubes that are cylindrical and are collapsible/expandable; said tubes that are collapsible to allow a central fusion of the first housing and the second housing; said tubes that could be expanded to make room for accommodating MDI between the first and the second housing; said tubes wherein each tube is connected to first and second housing via a single port or opening; said tubes wherein each tube after connection with the first housing splits into multiple micrometric openings; said multiple micrometric openings that are distributed along the circumference in the inlet of the first housing; said openings wherein air entrained into the first housing from the second housing does not interrupt or interfere with a plume generated by an MDI; said openings wherein aerosol generated by a nebulizer in the second housing enters the first housing via multiple micrometric openings distributed along entire circumference of the inlet of the first housing. 5) An aerosol inhalation apparatus of claim one, comprising: a universal MDI adapter that may be located at the inlet end of the central inlet tube of the first housing; the MDI adapter that may be used for delivering aerosol medication by actuation of MDI into the first housing; a nebulizer that may generate aerosol medication in the second housing; the first housing and the second housing that are connected at a central location by fusion of the outlet tube of the second housing to the inlet tube of the first housing, such as to form a passage to allow the aerosol medication to move between the two housings; the first housing and the second housing that may also be connected at peripheral locations by peripheral connecting tubes that are partially or fully collapsible/expandable such as to form a passage to allow the aerosol medication to move between the two housings. 6) The aerosol inhalation apparatus of claim 1: useable with a facemask to deliver a desired mixture of gas(es) with a desired density, viscosity, humidity, and fraction of inspired oxygen; useable with a facemask to deliver aerosol medication via an MDI and/or a nebulizer with a desired mixture of gas(es) with a desired density, viscosity, humidity, and fraction of inspired oxygen; useable in a ventilatory circuit by connecting the outlet tube at the outlet end of the first housing at one end of the ventilatory circuit and the inlet tube at the inlet end of the second housing at other end of the ventilatory circuit; 7) Aerosol inhalation apparatus of claims 2,3,4,5 and 6 comprising: a collapsible/expandable or fixed volume first housing; a fixed volume, or collapsible/expandable second housing; a central connection between the first and the second housing during nebulizer use and during delivery of a desired mixture of gases with or without aerosol medication delivery; one or more peripheral connections between the first and the second housing that are collapsible during nebulizer use and expandable during MDI use; the peripheral connections that permit delivery of a desired mixture of gas (es) with or without aerosol medication from the second housing to the first housing and hence to a patient; the peripheral connections between the first and the second housings that allow a desired mixture gas (es) to be delivered from the second housing to the first housing that is distributed in a pattern that does not interfere with a plume generated by the MDI or the nebulizer; first housing, second housing and/or reservoir that are all collapsible/expandable and could be used for pediatric and/or adult patients by expanding and/or collapsing the housings and/or reservoir to a precise desired volume; second housing that has a collapsible/expandable reservoir which may be a bag or a corrugated plastic tubing to store aerosol generated during exhalation, and to allow uniform mixing of one or more gases with aerosol medication to be delivered during inhalation to a patient; a second housing with one or more inlets for one or more gases to yield and deliver a gas mixture with a desired humidity, density, viscosity, and fraction of inspired oxygen to a patient; a closed circuit that serve as 100% non rebreather system with an inhalation valve assembly to prevent any air to be entrained from atmosphere into a circuit during inhalation and an exhalation valve assembly to allow exhaled air to exit a circuit into atmosphere and not allowing rebreathing of the exhaled air; a filter that is incorporated into the exhalation valve assembly to trap exhaled aerosol medication, allowing the exhaled gases to escape from the closed circuit to atmosphere and not permit entrainment of gases from atmosphere into the closed circuit; an enhanced aerosol delivery via MDI or nebulizer separately or simultaneously via MDI and nebulizer with delivery of a gas mixture of a desired density, viscosity, humidity, and fraction of inspired oxygen during aerosol delivery without disconnecting a patient from a desired gas source during aerosol delivery; a reservoir which may be moveable or could be repositioned in the apparatus such that it may be in front of the nebulizer, behind the nebulizer, connected to the nebuliser with a Y or Tee connector may be located in the second housing or be placed in the first housing before the inhalation valve assembly The collapsible/expandable first housing that may serve as a reservoir in a closed circuit to store aerosol medication during exhalation if expanded to a certain minimum volume to meet a patient's ventilatory requirement such that no additional reservoir bag or collapsible/expandable corrugated tube may be requited as a reservoir in the second housing; 8) An aerosol inhalation apparatus of claims 1 and 7 comprising: a single fixed collapsible/expandable or partially fixed and partially collapsible/expandable first housing; the housing has an outlet port for connection to a facemask or a mouthpiece; the outlet has two flap valve assemblies—an inhalation and an exhalation valve assembly; the housing that has an inlet port for connection with a boot adapter panel; the housing that has a port for a nebulizer and a reservoir that is disposed in a wall of the housing between the inlet and outlet ports; an inhalation valve assembly in the outlet tube of the first housing which may be a ball valve assembly and not a flap valve assembly such that inhalation by a patient triggers a ball to rise to a higher level and drop to it's original position during exhalation to allow one way flow of aerosol medication and/or gases to a patient and not allow any re-breathing of carbon dioxide exhaled by a patient. 